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The  Eighth  Yearbook 

OF  THE 


NATIONAL   SOCIETY    FOR    THE    SCIEN- 
TIFIC   STUDY    OF    EDUCATION 

Part  I 

EDUCATION  WITH  REFERENCE  TO  SEX 

PATHOLOGICAL,    ECONOMIC,    AND 
SOCIAL    ASPECTS 


BY 

Charles  Richmond  Henderson,  Ph.D. 

Professor  of  Sociology,  University  of  Chicago,  President  of  Chicago  Society  of  Social  Hygiene 
Associate  Member  of  American  Academy  of  Medicine 


THIS   YEARBOOK  WILL  BE  DISCUSSED  AT  THE  CHICAGO  MEETINGS  OF  THE 
NATIONAL  SOCIETY,   FEBRUARY  22  AND  24,   1909 


CHICAGO 

THE  UNIVERSITY  OF  CHICAGO  PRESS 

1909 


Copyright  1909  By 
Manfred  J.  Holmes 

SECRETARY  OF.THE  SOCIETY 


Published  February,  1909 


Composed  and  Printed  By 

The  University  of  Chicago  Press 

Chicago,  Illinois,  U.  S.  A. 


OFFICERS  AND  EXECUTIVE  COMMITTEE 


Charles  McKenny, 

State  Normal  School,  Milwaukee,  Wis. 

President 

W.  S.  Sutton, 
University  of  Texas,  Austin,  Texas 

J.  Stanley  Brown, 
Township  High  School,  Joliet,  111. 

Henry  Suzzallo, 
Columbia  University,  New  York,  N.  Y. 

Clarence  F.  Carroll, 
Superintendent  of  Schools,  Rochester,  N.  Y. 

Manfred  J.  Holmes, 

Illinois  State  Normal  University,  Normal,  111. 

Secretary-  Treasurer 


PAGE 


TABLE  OF  CONTENTS 

PART  I.     PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS 
OF  THE  PROBLEM 

Preface        7 

Wisdom,  timeliness,  and  necessity  of  this  study  for  the  teachers — 
General  considerations — Testimonies  in  respect  to  this  particular  book 
— The  purpose  and  scope  of  this  study — Historical  precedents: 
the  philanthropists. 

Chapter  I 2I 

Social  loss  from  sexual  vice — Neglect  of  well-meaning  citizens  largely 
due  to  ignorance  of  the  facts. 

I.  Medical  authorities  on  the  nature  of  the  social  damage  from  sexual 
vice.  Section  i,  Solitary  vice,  excess,  and  precocious  sexual  activity; 
Section  2,  Venereal  diseases  and  prostitution;  gonorrhea,  nature,  cause, 
and  effects;  syphilis,  nature,  cause,  and  effects;  no  sexual  necessity; 
prostitution  not  a  desirable  social  institution. 

II.  Economic  loss  by  sexual  vice. 

III.  Moral  degradation. 

Chapter  II 53 

Methods  of  social  control  and  movements  for  amelioration.  Relation 
of  legal  and  administrative  measures  to  education. 

I.  The  sanitary  point  of  view  and  the  policy  of  reglementation;  the 
policy  of  toleration  and  of  license,  on  the  basis  of  medical  inspection  and 
certification;   arguments  pro  and  con. 

II.  The  policy  of  repression;   the  "abolitionists." 

III.  The  policy  of  moral  regulation;  its  principles  and  methods;  various 
experiments  in  cities;  societies  and  movements;  all  legal  methods  de- 
pend for  efficiency  in  the  last  analysis  on  general  enlightenment;  hence 
the  duty  of  educators  to  be  leaders  in  this  movement  for  public  health 
and  morality. 

PART  II.     AGENCIES  AND  METHODS 

Preface    7 

Introduction 9 

Definition  of  "education." 

The  end  of  education:  (1)  personality,  (2)  social  obligation,  (3)  religion. 

Scope  of  educational  activity:   (1)  control,  (2)  instruction,  (3)  nurture. 

Co-operating  agents:  parents,  teachers,  church,  physicians,  authors,  and 

editors. 


6  THE  EIGHTH  YEARBOOK 

Chapter  I 13 

Care  of  infancy,  with  particular  reference  to  sex  life — Duty  of  parents — 
Who  shall  teach  ignorant  parents  ? — Personal  hygiene  and  training. 

Chapter  II 15 

Ideal  interests. 

Chapter  III 17 

Formal  instruction  in  matters  of  sex — Ignorance  part  of  cause  of  vice 
and  disease — Call  to  give  information — The  appeal  of  the  bishop  of 
London — Action  of  the  diocese  of  Massachusetts. 

I.  Necessity  of  instruction. 

II.  Legitimate  scientific  interest  of  every  person — child,  youth,  adult. 

III.  Difficulties  in  the  way  of  formal  instruction  in  this  subject. 

IV.  Paths  of  approach  for  formal  instruction:  (a)  nature-studies, 
biological  sciences;    (b)  hygiene;    (c)  physical  culture;    (d)  morality. 

V.  Selection  and  adaptation  of  materials  of  instruction;  stage  of  develop- 
ment of  pupil.  Section  1,  Childhood;  Section  2,  Puberty  and  early 
adolescence — boys;  question  of  separation  of  boys  from  girls  from  the 
twelfth  year;  agricultural  schools;  suggestive  counsels  of  experts;  "the 
boy  problem,"  by  a  member  of  the  American  Society  of  Sanitary  and 
Moral  Prophylaxis;  passages  from  Lyttleton,  "Training  of  the  Young 
in  Laws  of  Sex;"  citations  from  President  G.  S.  Hall's  Adolescence; 
Section  3,  Puberty  and  early  adolescence — girls;  Section  4,  High-school 
years;  instruction  of  apprentices;  high  schools;  principles;  methods; 
night  schools  as  an  opportunity;  continuation  schools;  Section  5,  College 
years — young  men;  illustrations;  "the  venereal  peril;"  letter  from  a 
physician  to  his  son  in  college. 

VI.  Training  of  teachers  for  this  task;  normal-school  preparation; 
plea  for  more  biology  and  hygiene. 

VII.  Preparation  of  young  parents  for  their  duties;   review. 

VIII.  The  religious  organizations. 

Appendix 59 

Summary  of  the  discussions  of  the  German  society  for  fighting  venereal 
perils  on  Socialpadagogik;  theses  and  conclusions  in  illustration — Paper 
by  Dr.  Helen  C.  Putnam  on  "Sex  Instruction  in  Schools,"  written  for 
this  volume — Bibliography. 

List  of  Active  Members  of  the  National  Society  for  the  Scien- 
tific Study  of  Education 85 


PREFACE 

No  apology  is  made  for  urging  upon  teachers,  the  moral  guides 
of  the  nation,  the  duty  of  helping  in  the  cause  of  fighting  the  black 
plague  of  the  world.  A  policy  of  concealment,  silence,  ignorance, 
and  quackery  has  borne  its  monstrous  brood  of  disease,  misery,  and 
moral  degradation.  A  false  modesty  is  guilty  of  much  of  this  giant 
wrong.  There  never  was  a  more  chivalrous  fight  for  pure  women 
and  innocent  childhood  than  that  on  behalf  of  which  this  book  is 
written.  Yet,  in  the  present  darkened  state  of  the  public  mind, 
itself  due  largely  to  past  ignorance  and  neglect  of  medical  men, 
teachers,  and  pastors,  some  explanation  is  necessary  of  the  plan  of 
this  study,  and  evidence  will  be  offered  that  it  is  timely  and  wholly 
necessary.  It  has  been  objected  to  this  study  at  this  time  that  it 
diverts  the  attention  of  teachers  from  the  consideration  of  their 
normal  task  to  exceptional  and  pathological  cases.  But  this  is  not 
a  fair  statement.  The  truth  is  that  our  schools  have  professed  to 
teach  physiology,  hygiene,  and  morality  and  have  neglected  vital 
factors,  the  function  of  elimination  of  waste  and  the  function  of 
reproduction.  Partly  in  consequence  of  this  neglect  we  have  sexual 
abuses,  excesses,  and  the  plagues  of  venereal  disease.  It  is  high 
time  to  recall  the  teaching  profession  to  its  duty,  in  order  that  the 
next  generation  of  parents  may  be  better  fitted  to  rear  and  educate 
a  wiser  and  healthier  race.  The  story  of  pathology  is  rehearsed 
only  to  demonstrate  the  necessity  of  a  complete  education  for  life. 
Some  good  and  wise  men  among  our  leading  educators  have  seri- 
ously questioned  the  timeliness  and  prudence  of  this  effort  to  inter- 
est teachers ;  and  they  say  that  others  should  first  break  ground  and 
prepare  the  soil.  But  who  are  these  others?  The  physicians? 
They  have  already  sounded  the  note  of  alarm  in  all  their  professional 
magazines.  They  have  organized,  in  New  York,  Chicago,  and 
other  cities,  associations  whose  purpose  it  is  to  lay  the  facts  before 
parents,  teachers,  pastors,  women's  clubs,  and  legislators.  The 
medical  men  have  done  their  duty.  How  long  should  members  of 
the  teaching  profession  wait?  How  many  more  thousands  should 
they  see  drag  their  miserable  way  to  physical  and  moral  ruin  before 

7 


8  THE  EIGHTH  YEARBOOK 

they  utter  a  protest  or  lend  a  hand  to  help?  The  right  time  to 
speak  and  write  and  teach  is  now.  For  multitudes  another  ten  years 
of  guilty  delay  would  mean  disaster.  Let  him  be  silent  who  can 
with  clear  conscience. 

The  first  draft  of  this  book  was  read  carefully  and  approved  by 
Dr.  J.  M.  Dodson,  dean  of  Rush  Medical  College,  Dr.  C.  P.  Small, 
physician  of  the  University  of  Chicago,  and  by  Dr.  W.  T.  Belfield, 
an  eminent  expert  in  venereal  diseases  and  secretary  of  the  Chicago 
Society  of  Social  Hygiene.  Suggestions  of  these  gentlemen  were 
utilized  to  improve  the  text.    Dr.  Belfield's  letter  is  here  reproduced. 

Chicago.  III.,  November  10,  1908 
Dear  Dr.  Henderson:  Have  just  finished  reading  your  MS.  As  you 
will  see  when  you  open  the  envelope,  I  took  a  sheet  and  started  "comments" 
with  references  from  your  pages.  But  I  now  feel  that  the  only  important 
comment  I  can  make  is  an  expression  of  warmest  admiration  for  both 
matter  and  manner.  I  can  really  suggest  no  changes  that  seem  to  me 
improvements,  beyond  the  few  pertaining  to  your  first  page.5,  already  noted. 
It  is  a  monograph  that  will  do  even  you  much  credit. 

Sincerely, 

Wm.  T.  Belfield 

A  few  encouraging  expressions  are  added  because  the  author 
really  needed  cheer  where  he  was  obliged  to  act  contrary  to  the 
judgment  of  some  men  whose  opinion  he  valued  and  whose  approval 
he  would  be  glad  to  win. 

Ex-Governor  W.  J.  Northen,  of  Georgia,  in  an  address  on 
"Civic  Righteousness  in  Georgia,"  before  the  Georgia  Baptist 
Convention,  December  2,  1908,  said :  "I  trust  that  every  citizen  who 
now  hears  me  will  study  closely  the  statements  in  Dr.  Henderson's 
book,"  and  he  urges  a  campaign  against  that  "social  institution  that 
has  stood  for  years  as  an  expression  of  our  community  life,  practi- 
cally without  challenge,  and  corrupting  the  morals  of  men  to  a 
most  alarming  degree." 

The  paper  written  for  presentation  has  proved  to  be  scholarly  and 
tactful  to  our  fullest  expectancy,  considering  the  nature  of  its  subject  matter. 
— Professor  Henry  Suzallo,  Teacher's  College,  Columbia  University. 

President  Charles  McKenny,  of  the  Wisconsin  State   Normal 


PREFACE  9 

School  and  of  the  Milwaukee  society  dealing  with  "social  hygiene," 
says: 

I  want  to  thank  you  and  congratulate  you  on  the  manuscript.  I  believe 
you  have  done  a  very  great  service  in  its  preparation.  Its  ideals  are  high, 
its  tone  pure,  its  conviction  strong,  its  facts  convincing. 

The  author  has,  upon  invitation,  co-operated  with  a  committee 
of  one  of  the  most  influential  societies  of  Chicago,  the  Chicago 
Womans'  Club,  and  this  volume  is  in  part  a  response  to  their  appeal 
to  all  citizens  for  help : 

The  preservation  of  the  moral,  mental,  and  physical  health  of  your 
own  and  the  interests  of  social  order  will  enlist  your  philanthropic  efforts  in 
this  world-wide  movement  of  moral  and  physical  portent. 

A  man  well  known  in  work  for  boys  and  young  men  writes  of 
the  need  of  this  effort : 

I  should  like  to  say,  however,  that  there  are  two  things  which  seem  to 
me  very  important  for  parents  and  teachers  to  realize.  The  first  is,  that 
the  existence  of  any  such  district  or  section  which  is  unrestrained,  as  this 
West  Side  district  was,  is  an  open  menace  to  the  physical  as  well  as  the 
moral  welfare  of  the  young  men  and  boys  of  the  community.  Indeed, 
the  attention  of  some  of  us  was  called  to  the  district  by  the  death  of  a 
16-year-old  lad,  as  a  direct  result  of  an  evening  spent  in  that  section.  The 
other  point  is  that  no  one  is  safe.  There  are  many  parents  and  teachers  as 
well,  who  have  the  feeling  that  because  they  live  in  a  good  section  of  the 
city  or  out  in  the  suburbs,  their  boys  are  safe  from  the  contaminating  influ- 
ences of  a  section  that  is  so  degraded  as  the  one  of  which  we  are  speaking. 
No  more  serious  mistake  could  be  made.  Hundreds  of  boys  who  would  not 
deliberately  start  out  to  go  in  a  house  of  ill  fame  of  any  class  will  be  led 
by  morbid  curiosity,  and  in  crowds,  into  a  section  where,  as  they  say  to 
themselves,  they  can  see  the  sights  without  going  into  danger.  The  first 
thing  they  know  they  are  swept  off  their  feet. 

Those  who  conducted  the  investigations  in  that  section  during  the  last 
few  months  found  men  and  boys  from  all  over  the  city  and  from  some  of 
the  best  homes  in  the  suburbs  thronging  the  streets.  It  was  a  common 
experience  to  find  from  two  to  three  thousand  men  and  boys  in  that 
district  in  a  single  hour,  and  they  were  by  no  means  all  of  them  from  the 
lower  class.  In  a  matter  of  this  kind  it  is  certainly  well  for  us  all  to 
remember  that  not  one  of  us  is  living  to  himself  alone,  and  that  so  long  as 
people  are  ignorant  of  the  terrific  dangers  involved,  someone  has  neglected 
his  duty. — Herbert  W.  Gates. 


IO  THE  EIGHTH  YEARBOOK 

The  dean  of  women  in  the  University  of  Chicago  expresses 
this  judgment: 

Race  suicide  and  divorce  are  symptoms  of  a  social  disorder,  doubtless 
very  grave  and  certainly  very  evident,  whose  remedy  in  my  opinion  lies  in 

the  direction  of  training  both  boys  and  girls  for  parenthood If  boys 

were  taught  the  principles  of  social  hygiene  and  their  part  in  maintaining 
life  upon  high  levels,  I  can  but  believe  that  with  their  increased  knowledge 
their  moral  natures  would  be  aroused  and  strengthened  and  the  difficulties 
by  which  all  teachers  who  deal  with  young  boys  are  baffled  would  largely 
disappear.  Without  analogous  training  for  girls  we  cannot  expect  that  .... 
good  conditions  ....  will  necessarily  produce  good  mothers.1 

We  are  simply  taking  up  a  line  of  educational  effort  which  was 
carried  far  by  the  "Philanthropists"  of  the  eighteenth  century,2 
and  then  long  neglected. 

The  Illuminists  discovered  and  discussed  practically  all  the  prob- 
lems touched  in  this  volume.  It  is  true  they  had  not  the  scientific 
equipment  which  is  at  our  disposal ;  they  did  not  know  the  specific 
germs  which  cause  venereal  diseases ;  they  could  have  improved 
their  instruction  by  later  discoveries  in  anatomy,  embryology,  and 
the  laws  of  evolution.  But  they  had  a  knowledge  of  the  essential 
facts  of  the  sexual  life,  of  birth  and  growth,  of  the  influence  of  the 
sexual  appetite,  and  of  some  of  the  dangers  of  prostitution.  They 
knew  the  value  of  instruction  in  preserving  youth  from  vicious 
conduct,  and  they  gave  to  knowledge  an  even  more  important  place 
than  it  deserves.  In  spite  of  much  that  is  grotesque,  coarse,  and 
ridiculous,  they  left  to  us  many  precious  suggestions  in  matters  of 
principle.  They  were  fully  aware  of  the  danger  of  giving  instruc- 
tion about  conception,  birth,  and  secret  and  social  vice,  and  the  wise 
men  sought  to  teach  without  morbid  excitement  and  premature 
awakening  of  curiosity.  They  studied  the  problems  of  feeling  in 
relation  to  the  subject;  the  cultivation  of  modesty  and  shame;  the 
influence  of  nudity  and  dress ;  the  preservation  of  modesty. 

They  gave  careful  attention  to  the  management  of  the  appetites, 
the  direction  of  the  will,  and  the  formation  of  wholesome  habits. 

1  Professor  Marion  Talbot,  in  a  paper  before  the  American  Sociological 
Society,  December,   1908. 

-  Franz  Xaver  Thalhofer,  Die  sexuelle  P'ddagogik  bei  den  Philanthropen, 
1907. 


PREFACE  II 

They  discriminated  carefully  between  the  normal  and  the  unwhole- 
some manifestations  of  sexual  life  and  studied  the  methods  of  inhi- 
bition and  the  reinforcement  of  character  by  idealistic  and  religious 
motives.  They  availed  themselves  of  the  best  medical  counsel  in 
relation  to  a  regime  of  hygienic  conduct  in  the  control  of  the  lower 
instincts  and  impulses.  The  names  of  Rousseau,  Basedow,  Salz- 
mann,  and  Campe,  are  connected  with  this  pedagogical  study  and 
their  contributions  have  been  considered  in  the  preparation  of  this 
volume. 

For  many  reasons  the  subject  has  been  greatly  neglected  among 
teachers  until  medical  men  alarmed  the  thoughtful  with  their  dis- 
coveries of  the  ravages  of  venereal  diseases,  their  prevalence  among 
young  men  in  large  towns  of  Europe  and  America,  and  the  dangers 
to  women  and  families  from  this  source.  Since  ignorance  and 
neglect  of  proper  training  are  part  cause  of  these  evils  the  pro- 
fessional duty  of  teachers  has  been  made  too  plain  to  permit  longer 
neglect. 

An  extended  treatment  of  sexual  education  may  give  to  persons 
unfamiliar  with  the  situation  a  wrong  impression  of  the  central 
purpose  of  the  writer.  It  is  the  clear  and  decided  conviction  of  the 
author  that  instruction  in  matters  of  sex  should  be  a  natural  part 
of  general  education;  that  it  should  not  be  over-emphasized  with 
pupils  by  calling  special  attention  to  it  and  by  isolating  it  from 
other  studies ;  that  the  instruction  should  be  brief,  simple,  and 
free  from  embarrassment.  It  may  seem  at  a  hasty  glance  that  this 
present  discussion  violates  these  principles ;  but  in  all  fairness  the 
reader  must  consider  that  this  yearbook  is  for  mature  persons  who  are 
capable  of  following  an  objective  and  scientific  argument  without 
harm,  and  that  it  is  no  more  intended  for  general  reading  than  any 
professional  medical  book.  The  investigation  was  taken  up  and  the 
treatise  written  at  the  earnest  request  of  the  Executive  Committee 
of  a  society  of  responsible  educators  who  had  the  conviction  that 
they  could  not  neglect  the  subject  without  failure  in  their  official 
duty.  The  writer  himself  had  for  some  years  been  compelled  by  his 
own  university  duties,  by  his  position  as  president  of  the  Chicago 
Society  of  Social  Hygiene,  and  as  trustee  of  schools  for  erring 
girls,  and  by  his  investigations  of  pauperism,  crime,  and  industrial 
conditions  in  cities,  to  face  this  forbidding  problem  and  seek  light 


12  THE  EIGHTH  YEARBOOK 

for  its  solution.  With  men  and  women  who  have  come  in  contact 
practically  with  the  evil  consequences  of  sexual  error  and  wrong, 
as  confidential  advisers  of  youth,  no  apology  for  this  work  will  be 
needed. 

Neither  completeness  nor  freedom  from  error  is  claimed ;  but 
the  writer  has  earnestly  sought  the  best  sources  of  information, 
has  faithfully  questioned  many  professional  persons  whose  knowl- 
edge and  character  entitle  them  to  consideration,  has  examined  a 
large  number  of  recent  works  of  Europe  and  America,  and,  finally, 
has  set  down  the  results  in  plain,  simple,  direct  speech,  with  the 
confident  hope  that  all  sensible  and  earnest  teachers  will  appreciate 
the  difficulty  of  the  subject  and  weigh  the  argument  without 
prejudice. 

On  one  side  there  has  been  much  exaggeration  and  sensational 
overstatement,  with  unreasonable  alarm,  and  not  seldom,  especially 
in  certain  novels,  with  an  appeal  to  the  salacious  demands  of  their 
customers  for  pornographic  stories.3  Some  story  makers  of  "best 
sellers"  find  normal  life  too  dull  for  spicy  fiction,  and  are  often 
inclined  to  select  pathological  and  monstrous  characters  as  types  of 
modern  society,  forgetting  that  the  freaks  in  side-shows  on  circus 
days  are  not  specimens  of  normal  and  healthy  men  and  women. 
But  on  the  other  hand  men  and  women  who  have  been  brought  up 
in  sheltered  homes  and  kept  free  from  contact  with  the  depraved, 
may  rest  in  ignorance  of  the  tragedies  which  threaten  the  inno- 
cent children  in  their  schools  and  families,  and  so  unwittingly 
neglect  those  measures  of  precaution  which  an  instructed  and  con- 
scientious school  official  would  take  if  he  knew  the  facts. 

Young  people  who  are  secretly  going  astray  rarely  make  confi- 
dants of  teachers ;  when  trouble  comes  they  seek  a  physician  who, 
like  any  faithful  father-confessor,  buries  their  story  under  pro- 
fessional confidence.  They  are  fortunate  if  they  do  not  fall  into 
the  hands  of  some  miserable  charlatan  who  both  corrupts  and  robs 
them.     It  is  not  surprising  that  many  teachers,  even  of  long  experi- 

3  Dr.  Howard  A.  Kelly  {Medical  Gynecology,  p.  292)  uses  a  homely  illus- 
tration to  impress  the  danger  of  exaggeration  :  "On  all  sides  of  such  questions 
one  must  beware  of  exaggeration.  'The  diff'rence,'  says  the  astute  Dooley, 
'between  Christyan  Scientists  an'  doctors  is  that  Christyan  Scientists  think 
they-se  no  such  thing  as  disease,  an'  doctors  think  there  ain't  annythin'  else.'  " 


PREFACE  13 

ence,  should  be  unacquainted  with  these  hidden  evils.  In  the  course 
of  preparation  of  these  pages  about  390  letters  were  sent  to  super- 
intendents of  schools  in  towns  and  cities  throughout  the  United 
States.  Forty-two  replies  were  received;  neglect  of  the  others  is 
due  to  various  causes.  In  answer  to  the  question:  "Do  you  per- 
sonally know  of  cases  of  illicit  sexual  intercourse  by  high-school 
pupils?"  the  replies  indicated  that  19  knew  of  84  cases  of  boys  and 
44  cases  of  girls  at  some  time  within  the  past  years  of  their  experi- 
ence; 13  cases  of  illegitimate  births  were  reported.  The  others  did 
not  personally  know  of  any  such  cases.  In  reply  to  the  question : 
"Do  you  personally  know  of  cases  of  venereal  diseases — gonorrhea, 
syphilis,  or  other?"  the  replies  showed  that  12  knew  of  15  cases  of 
boys  and  3  cases  of  girls ;  in  all  probability  reported  to  them  by 
physicians.  The  answers  to  the  questions  about  the  corruption  of 
pupils  by  persons  of  vicious  behavior  and  about  the  effects  of  secret 
vice  were  too  vague  to  furnish  any  information  of  value.  This 
imperfect  response  may  be  interpreted  in  various  ways.  Does  it 
mean  that  superintendents  are  not  acquainted  with  the  facts  ?  When 
a  superintendent  of  long  experience  in  a  renowned  city  declares 
that  he  never  personally  knew  a  single  case  of  the  kinds  mentioned, 
is  that  proof  that  none  or  few  occurred?  Does  it  mean  that  super- 
intendents fear  to  offend  their  constituencies?  Does  it  imply  that 
they  dislike  to  touch  the  subject?  Does  their  silence  or  their  testi- 
mony prove  that  high-school  morality  is  what  every  patriotic  Ameri- 
can would  like  to  have  it?  One  explanation  is  obvious  enough: 
high-school  pupils  are  from  the  better  families  and  have  care  and 
breeding  above  the  average  youth.  It  is  also  true  that  lads  of  high- 
school  age  are  not  yet  supplied  with  money  to  spend  on  harlots. 
The  writer  believes  from  considerable  observation  and  inquiry  that 
our  youth  in  high  schools  are,  generally  speaking,  under  the  sway 
of  influences  which  protect  them  at  this  age  from  the  baser  forms  of 
vice. 

This  optimistic  interpretation,  however,  is  somewhat  discounted 
by  the  suggestion  of  a  high  medical  authority  who  was  asked  for 
an  explanation:  "That  superintendents'  claim  that  high  schools  do 
not  offer  a  problem  can  be  refuted  by  almost  any  broad-minded 
instructor  in  them;  also  by  college  physicians'  experiences  with 
entering  freshmen." 


14  THE  EIGHTH  YEARBOOK 

We  must  turn  to  physicians,  dispensaries,  and  hospitals  for  our 
knowledge  on  this  subject;  and  their  evidence,  so  far  as  it  is  accessi- 
ble, will  be  presented. 

Most  of  the  children  leave  public  schools  before  the  period  of 
storm  and  stress.  Vicious,  enfeebled,  and  perverted  children  are 
expelled  and  deprived  of  education  or  sent  to  reform  schools.  Only 
the  selected  and  ambitious  youth  from  fairly  cultivated  families  go 
through  high  school.  It  is  not  at  all  strange,  therefore,  that  many 
superintendents  and  principals  should  be  ignorant  of  the  extent  of 
the  venereal  peril  and  seem  inclined  to  be  incredulous  when  medical 
men  reveal  the  facts. 

EXTRACTS   FROM   LETTERS  BY  SUPERINTENDENTS   OF   SCHOOLS 

I  am  sure  that  the  evil  is  of  sufficient  importance  to  justify  our  thought 
on  the  matter.  If  there  was  general  publicity  and  concerted  action  I  am 
sure  great  good  might  be  done.  M. 

This  is  a  delicate  matter.  With  young  children  it  must  be  attended  to 
by  parents.  The  influence  of  societies  must  be  to  arouse  parents  as  to  the 
seriousness  of  the  subject,  rather  than  to  reach  the  children  directly.  Dis- 
creet teachers  may  co-operate,  and  with  the  consent  of  parents  may  give 
the  necessary  instruction.  With  children  in  the  upper  grades  and  high 
school  the  topic  should  be  treated  in  books  on  physiology  and  hygiene,  in 
a  simple,  clear,  direct,  and  authoritative  way.  These  portions  of  the  book 
need  not  be  taken  up  in  class,  but  it  is  certain  that  all  children  will  read 
them.  I  have  had  fairly  authoritative  information  that  there  is  great  pre- 
valence of  venereal  disease  among  college  students.  N.  H. 

Teaching  should  be  through  elementary  biology  or  nature-study.  Have 
straightforward  talks  to  the  girls  by  wholesome  lady  teachers — to  the  boys 
by  a  strong,  clean  male  teacher,  and  lectures  by  physicians.  P. 

I  have  no  personal  knowledge  such  as  the  inquiries  suggest.  B. 

I  think  facts  should  be  taught  in  connection  with  science  at  high-school 
age,  orally.  P. 

I  advise  required  biology  for  one  year  in  all  high  schools ;  nothing 
else.  I  went  to  medical  school  two  years  and  have  had  my  eye  on  this  ever 
since.  Sex  teaching  by  celibate  men  and  women  is  absurd,  childish,  and 
impossible.  The  subject  is  for  parents  only.  Children,  I  think,  must  not  be 
given  books  to  read  alone.  It  induces  masturbation.  God  knows  things 
are  bad  enough,  but  America  is  not  yet  like  Europe.  W. 


PREFACE  15 

I  am  sorry  to  say  we  do  not  teach  these  important  facts.  A. 

The  superintendent  knows  nothing  wrong  in  this  city  and  said  he 
would  not  teach  anything  on  the  subject.  E. 

Great  care  is  necessary  to  avoid  aggravating  the  evil  in  the  case  of  chil- 
dren and  early  youth.  The  high-school  teacher  in  physiology  can  give 
instruction  to  adolescents  better  than  anyone  else.  He  approves  the  cir- 
culars of  the  State  Health  Department  of  Indiana  and  thinks  they  could  be 
handed  to  high-school  students  after  a  talk  by  the  teacher  of  physiology. 
He  knows  a  few  cases  of  scandal.  K. 

[To  instruct  children  he  knows  of  no  way  except  by  plain  instruction 
by  parents.  In  high  school,  botany,  biology,  and  physiology  are  good 
means  of  teaching.]  I  am  deeply  interested  in  this  study;  we  all  need  light 
on  the  subject.  At  present  I  think  the  whole  subject  of  sexual  hygiene  is 
left  to  the  home,  where  it  is  greatly  neglected.  In  the  high  schools  some- 
thing should  be  done  where  the  homes  neglect  the  matter.  The  question  is 
how  and  what.  R. 

Instruction  of  children  should  be  by  parents  in  the  home.  Instruction 
of  youth  should  be  in  the  science  work  in  the  high  school  where  sexes  can 
be  segregated.  [He  approves  the  books:  What  a  Boy  Should  Know  and 
What  a  Girl  Should  Know.  The  subject  is  best  taught  early  by  parents 
or  teachers  of  segregated  pupils.]  A. 

There  are  many  suspicions  floating  around,  but  no  accurate  infor- 
mation. The  outlook  is  to  me  as  if  much  of  this  should  be  talked 
among  parents ;  first  at  mothers'  meetings  and  fathers'  meetings  to  prepare 
them  for  such  sex  teaching  as  this  circular  suggests.  I  have  not  seen 
anything  printed  which  I  thought  suitable  to  put  in  the  hands  of  the  young. 

G. 

[He  says  that  the  subject  is  generally  avoided  by  teachers  and  that  he 
knows  of  no  suitable  publications  for  children  and  youth.]  C. 

In  this  city  we  have  separate  high  schools  for  boys  and  girls.  Some 
years  ago  a  teacher  of  physiology,  who  was  a  graduate  in  medicine  pro- 
posed to  give  talks  to  the  boys  on  the  use  and  abuse  of  the  sexual  organs. 
Before  doing  so  he  wrote  to  the  parents  of  the  boys  asking  permission  and 
explaining  what  he  proposed  to  do.  His  request  was  met  with  a  storm  of 
indignant  protest  and  he  was  forced  to  abandon  his  effort.  [This  super- 
intendent thinks  that  talks  to  the  boys  by  the  teacher  who  has  the  con- 
fidence of  the  pupils  is  the  best  method.  For  boys  a  male  teacher — for 
girls  a  female  teacher.]  L. 


16  THE  EIGHTH  YEARBOOK 

I  am  glad  you  have  taken  this  matter  up.  I  hope  you  will  learn  that  the 
scare-heads  of  the  press  are  unwarranted.  Certainly  among  high-school 
boys  and  girls  in  New  England  these  evils  are  almost  unknown.  Some 
principals  have  lectured  to  pupils  on  this  abuse.  I  doubt  the  value  of  such 
work.    All  the  books  are  of  very  doubtful  value,  I  fear  they  excite  lust.  H. 

[Recommends  talks  to  high-school  boys  by  the  principal  of  the  school 
and  to  high-school  girls  by  woman  physicians  and  instructors  in  gymnasium.] 

S. 

In  my  opinion  this  work  should  reach  the  parents.  The  subject  in  the 
schools  is  attended  by  many  and  almost  insuperable  difficulties.  The  parent 
is  the  proper  one  to  reveal  these  things  to  the  children.  F. 

I  do  not  know.     I  am  deeply  ignorant  on  all  these  matters.  S. 

[The  superintendent  has  never  known  of  a  case  of  sexual  immorality 
in  his  schools.  The  answers  are  based  on  considerable  experience  as  high- 
school  teacher  and  principal.]  I  am  of  the  opinion  that  conditions  are  not 
so  bad  as  many  people  attempt  to  show  them.  [He  gives  no  suggestions 
for  instruction,  evidently  thinking  that  none  are  necessary.]  B. 

Children  ought  to  be  looked  after  by  parents,  Wise  teachers  can  give 
enough  instruction.  For  children  at  the  age  of  puberty  hygienic  instruc- 
tion by  occasional  talks  may  be  given.  For  youth  more  can  be  done  than 
has  yet  been  done,  especially  in  connection  with  biology.  We  have  had 
talks  by  physicians  for  boys.  K. 

About  puberty  instruction  should  be  general  and  can  be  given  by  the 
parent  or  one  in  a  similar  relation.  S. 

Children  are  best  taught  by  mothers,  not  teachers,  by  telling  the  stories, 
in  a  beautiful  way  before  they  get  information  in  a  gross  way.  Books 
should  be  used  by  parents  or  prescribed  with  the  parents'  consent.  Do 
not  try  to  get  this  done  through  schools ;  let  parents  and  the  churches  deal 
with  it.  Would  you  want  a  teacher  to  talk  about  this  matter  with  your 
boy  or  girl  and  in  the  presence  of  man}-  others?  Parents  are  getting  to  be 
more  negligent  and  your  efforts  should  be  toward  educating  parents  in  the 
manner  of  presenting  these  important  matters  to  their  young.  Parents 
must  not  abdicate  their  parenthood  entirely  to  teachers.  We  are  drifting 
too  much  that  way.  The  American  Motherhood,  the  Ladies'  Home  Journal, 
and  other  publications  are  fast  educating  mothers  on  this  subject.  W. 

Instruction  should  be  given  by  parents  to  children,  especially  by  mothers 
to  their  daughters.  Youth  may  be  taught  by  lectures  given  to  students,  the 
girls  and  boys  being  in  separate  classes.    I  do  not  know  any  publications  on 


PREFACE  17 

the  subject  that  do  not  need  some  expurgating.  Should  be  glad  to  know 
of  any  that  do  not  need  this.  I  believe  morality  the  strongest  element  in 
appealing  to  students,  that  is  those  we  are  trying  to  teach,  next  comes 
healthy  bodies  connected  with  happiness.  M. 

Intelligent  mothers  can  do  more  than  all  others.  [He  recommends  the 
"Self  and  Sex  Series."]  A. 

Children  cannot  be  taught  in  the  schools.  Private  talks  are  used  for 
youth.  In  cases  of  later  adolescence  there  is  no  occasion  for  calling  special 
attention  to  it.  I  should  avoid  suggestive  books.  Have  little  knowledge, 
but  have  used  a  few  talks  in  some  cases.  E. 

We  unfortunately  give  no  instruction  on  sex  questions.  [As  to  books, 
replies :  "Am  not  posted."]  B. 

I  have  had  so  little  contact  with  such  evils  that  I  have  given  little  study 
to  this  subject.  Sorry  not  to  be  able  to  suggest  even  one  book  on  the 
subject.  W. 

No  doubt  some  of  the  evils  mentioned  here  occur,  but  personally  I  have 
no  knowledge  of  any  of  them.  S. 

No  direct  reference  to  such  subject  has  been  made  in  any  systematic 
way.     I  am  not  familiar  with  the  publications.  D. 

Your  letter  making  inquiry  in  reference  to  certain  diseases  in  our  schools 
has  been  received.  In  reply  I  would  say,  that  we  do  not  get  into  contact 
with  such  cases  as  you  describe.  R. 

The  usual  sex  books  are  poor  indeed.  Talks  by  the  right  person  at 
the  right  time  may  do  good.  I  do  not  know  of  any  ideal  book;  wish  I  did. 
The  one  I  like  best  is  Burt  Wilder's  What  Young  People  Ought  To  Knozv. 

T. 

On  all  these  problems  I  am  at  sea.  R. 

EXTRACTS  FROM  LETTERS  OF  PHYSICIANS 

In  my  private  practice  as  a  genito-urinary  specialist  I  see  very  few 
cases  of  acute  gonorrhoea.  Boys  and  young  men  first  go  to  a  drug  store 
or  use  some  remedy  suggested  by  a  friend.  Later  they  go  to  a  general 
practitioner,  and  only  the  cases  that  they  do  not  cure  come  to  a  specialist. 
I  believe  that  boys  and  girls  at  the  age  of  puberty  should  be  carefully 
taught  the  anatomy  or  physiology  of  the  sexual  organs  and  the  diseases 
that  follow  abuse  or  which  may  be  contracted.  I  think  this  can  best  be  done 
by  talks  illustrated  by  charts.  I  am  much  interested  in  the  subject  and 
have  suggested  such  talks  to  some  good  people  who  think  it  ought  to  be 


1 8  THE  EIGHTH  YEARBOOK 

done,  but  will  not  take  the  responsibility  of  starting  the  matter.    They  would 
regard  such  things  as  not  proper.  W. 

[Recommends  segregation  of  prostitution  and  favors  instruction. 
Thinks  that  boys  should  be  taught  by  the  father  and  girls  by  the  mother 
under  the  direction  of  a  physician.]  The  reading  of  properly  prepared 
books  of  which  I  do  not  know  any  published  entirely  satisfactory.         E. 

In  my  opinion  father  and  mother  should  not  permit  children  to  go  any- 
where after  8:00  or  9:00  p.m.  After  the  fourteenth  or  fifteenth  year 
parents  should  carefully  explain  sexual  hygiene  to  their  children.         M. 

[Recommends  publications  of  the  Social  Purity  League.]  G. 

[Recommends  examination  of  the  sanitary  conditions  of  the  houses  of 
prostitution,  because  the  prostitute  is  not  as  liable  to  be  infected  or  to 
infect  somebody  else  if  she  is  clean  and  in  good  general  health.  Special 
attention  should  be  paid  to  young  girls  who  just  start  that  kind  of  a  life 
because  their  infections  are  worse  and  they  attract  more  males.  Forbid 
the  owners  of  such  houses  to  hire  a  physician  to  look  after  their  girls. 
Recommends  examination  of  children  in  schools  and  instruction  of  the 
mothers,  because  the  mother  needs  instruction  most  and  she  stands  nearest 
to  her  offspring.]  B. 

A  WOMAN  PHYSICIAN,  HEAD  OF  AN  IMPORTANT  HOSPITAL 
My  practice  is  mostly  in  a  maternity  hospital  and  about  25  per  cent  of 
all  cases  handled  have  gonorrhoea  either  in  acute  or  chronic  state.  We 
exclude  acute  cases  when  possible.  We  have  at  least  half  or  more  of  mar- 
ried women  from  good  respectable  families  nearly  all  unconscious  of  their 
malady. 

My  opinion  on  the  regulation  of  prostitution  is  similar  to  the  regula- 
tion of  saloons.  Get  rid  of  them  as  early  as  possible  by  the  education  of 
the  young  as  to  their  evil  results.  While  they  exist  make  them  as  unprofita- 
ble as  possible  by  expensive  fines  and  removals.  A  business  that  moves  its 
location  frequently  loses  trade.  No  regulation  that  is  not  seeking  for  an 
extermination  of  these  things  is  worth  considering. 

Parents  should  be  the  first  teachers  of  the  young  on  sexual  hygiene. 
It  should  come  easily  with  the  care  of  the  body  and  the  explanation  made 
of  the  birth  of  babies  and  animals  which  they  learn  of  in  the  course  of 
family  events.  The  teacher  in  school  should  take  up  the  anatomy  and 
physiology  of  reproduction  as  the  child  progresses  at  the  twelfth  or  four- 
teenth year  or  even  earlier  when  possible,  by  means  of  plants,  etc.  The 
high-school  pupils  should  be  taught  something  of  venereal  diseases  by  special 
lectures  in  separate  classes  and  the  story  of  human  reproduction  must  be 


PREFACE  19 

made  clear,  and  the  young  mind  may  be  impressed  as  in  a  religious  appeal. 
Each  high  school  should  have  such  an  instructor  and  in  large  cities  one 
speaker  can  instruct  all  of  the  schools,  the  parents  first  being  asked  to 
listen  to  the  talk  and  after  hearing  it  shall  decide  whether  or  not  they 
wish  their  children  to  sit  for  it  All  academies  and  young  people's  organ- 
izations should  be  presented  with  such  a  lecture  The  consequences  of 
improper  sexual  relations  should  in  all  instances  be  made  known  to  pupils 
of  the  high-school  age  and  hinted  at  in  the  presence  of  younger  children. 
In  giving  the  lecture  to  parents  first,  they  will  be  instructed  often  where 
they  would  be  left  ignorant,  if  they  had  not  heard  the  talk,  of  the  very 
things  which  their  children  need  to  know  in  order  to  fear  the  consequences 
in  loose  associations.  A  stricter  chaperonage  of  both  boys  and  girls  in  the 
high-school  age  should  be  urged  upon  American  parents.  D. 

[Thinks  that  prostitution  should  be  under  state  supervision  and  segre- 
gation. Instruction  should  not  be  given  to  children  in  school  or  in  groups, 
but  by  father  and  mother  if  the  child  is  sensible,  or  by  the  family  physician 
if  the  child  is  easily  led  or  nervous.]  I  believe  men  should  be  as  chaste  as 
women  and  that  this  can  be  accomplished  by  education  in  respect  to  the 
moral  obligation  of  high-school  and  college  men. 

The  condition  of  things  in  a  reform  school  for  girls  may  be  shown  by 
this  statement:  Of  1,305  girls  admitted  since  1895,  363,  or  27  per  cent, 
were  immoral,  but  not  diseased ;  47,  or  3  per  cent,  had  been  mothers,  when 
they  were  admitted ;  92  or  7.4  per  cent  had  syphilis,  and  50  of  these  had 
gonorrhoea  also;  777  were  admitted  with  gonorrhoea  (51.4  per  cent.); 
approximately  58.7  per  cent,  had  venereal  diseases  when  admitted.  W. 

[Thinks  that  instruction  should  be  given  in  the  family  by  parent  of  the 
same  sex  as  the  child;  and  in  school  by  special  instruction  of  a  physician  in 
classes  of  one  sex  only.]  B. 

[Thinks  that  prostitutes  should  be  licensed  and  inspected  and  kept  in  a 
"red-light"  district.  As  to  method  of  instruction  thinks  no  one  method 
will  do  for  all.  There  are  as  many  good  methods  as  there  are  men  and 
women  in  the  world.]  W. 

I  think  a  well-instructed  mother  should  be  the  instructor  of  her  chil- 
dren and  the  instruction  should  be  given  as  early  as  the  child  mind  expands 
and  his  curiosity  is  aroused.  A. 


CHAPTER  I 

SOCIAL  LOSS  FROM  SEXUAL  VICE.     ECONOMIC  ASPECTS 

The  notorious  indifference  and  neglect  of  this  subject  by  other- 
wise earnest  and  thoughtful  people  who  desire  the  common  wel- 
fare must  be  largely  due  to  the  general  ignorance  of  the  damage 
which  the  nation  suffers  from  the  various  forms  of  sexual  vice. 
The  attitude  of  the  unclean  is  easily  explained;  they  are  ready  to 
sacrifice  others  and  themselves  to  appetite  and  lust,  and  they  become 
deaf  to  argument  and  appeal  in  consequence  of  the  debasing  influ- 
ence of  immoral  indulgence  and  corrupting  companionships.  The 
present  study  seeks  to  present  ascertained  facts  to  a  group  of  per- 
sons known  to  be  devoted  to  public  service  and  open  to  the  influence 
of  arguments  drawn  from  careful  and  sober  presentation  of  the 
real  conditions.  The  volume  is  not  intended  for  circulation  except 
among  mature  and  professional  persons  whose  duties  compel  them 
to  deal  daily  with  young  people  who  are  exposed  to  temptation  and 
peril.  Plain  speech,  technical  only  when  necessary,  will  be  used 
throughout. 

We  have  used  well-authenticated  sources,  and  the  conclusions 
stated  are  drawn  up,  so  far  as  possible,  in  the  exact  language  of 
medical  authorities  in  responsible  positions,  and  the  whole  carefully 
revised  by  physicians  competent  to  discern  and  correct  error  in 
language  or  interpretation. 

It  must  be  remembered  that  the  contemporary  judgments  of 
competent  physicians,  specialists  in  the  particular  field,  rest  upon 
a  wide  observation  of  facts  and  are  inductions  from  a  vast  ex- 
perience, as  well  as  from  laboratory  and  clinical  experimentation. 
These  physicians  of  scientific  training  would  be  the  last  men  to 
affirm  that  investigation  is  closed,  that  all  is  known,  and  that  noth- 
ing remains  for  study.  But  for  the  laity  the  consensus  of  opinion 
of  the  medical  men  at  a  given  time  is  the  most  accurate  statement  of 
the  facts  which  is  accessible  to  them.  And  it  is  remarkable  that, 
on  our  present  subject,  there  is  practical  unanimity  in  regard  to  the 
physical  facts  with  which  we  have  to  deal,  much  as  men  differ  in 


22  THE  EIGHTH  YEARBOOK 

regard  to  the  more  complicated  and  involved  problems  of  social 
policy  and  methods  of  popular  education. 

This  is  not  a  medical  work  and  no  more  details  will  be  given 
than  are  absolutely  necessary  to  make  teachers  aware  of  the  nature, 
causes,  and  effects  of  the  principal  venereal  diseases  which,  in  the 
opinion  of  the  greatest  physicians,  threaten  the  welfare  of  the  race. 

I.       MEDICAL  AUTHORITIES  UPON  THE  NATURE  OF  THE  SOCIAL  DAMAGE 

FROM  SEXUAL  VICE 

The  chief  physical  evils  arising  from  ignorant  or  wilful  per- 
version of  the  sexual  functions  are  those  of  masturbation,  excessive 
indulgence  of  the  sexual  appetite  even  in  marriage,  and  the  venereal 
diseases  caused  primarily  and  principally  by  prostitution.  Of  the 
comparatively  rare  pathological  and  abnormal  cases  little  need  here 
be  said;  they  are  to  be  treated  by  physicians  rather  than  by  teach- 
ers. Yet  sexual  perverts  are  occasionally  discovered,  not  only  in 
reform  schools  but  also  in  ordinary  public  schools,  and  it  is  exceed- 
ingly important  that  medical  inspectors  find  them  out  before  they 
corrupt  normal  children.1 

Section  i.  Physical  and  psychical  disturbances  caused  by  mas- 
turbation 2  and  by  excessive  indulgence  of  the  sexual  appetite,  even 
in  normal  marital  relations. — Here  also  may  be  mentioned  the  danger 
of  precocious  indulgence  and  illegitimacy,  (a)  Self-abuse  is  the  cause 
of  disorders  when  it  is  frequently  repeated  and  long  continued.  But 
false  and  exaggerated  statements  are  frequently  made  current  by 
quack  doctors  who  become  rich  by  advertising  their  nostrums  after 
exciting  the  terror  of  youth.  Medical  authority  can  be  cited  for  a 
sober  and  reliable  description  of  the  facts,  although  there  is  a  wide 
range  of  variation  due  to  individual  differences  in  constitution, 
vitality,  occupation,  and  temperament,  (b)  Excessive  indulgence 
in  sexual  appetite,  without  exposure  to  venereal  diseases,  may  lead 
to  physical  and  mental  disorders  of  a  grave  character,  both  in 
illicit  intercourse  and  in  marriage.     We  exclude  illicit  intercourse 

1  These  inherited  pathological  conditions  are  discussed  with  authority  by 
R.  von.  Krafft-Ebing,  Psychopathia  Sexualis,  translated  by  F.  J.  Rebman  from 
the  1 2th  German  ed. ;  Forel,  Die  sexuelle  Frage ;  cf.  G.  F.  Lydston,  The  Diseases 
of  Society. 

2  Dr.  H.  A.  Kelly,  Medical  Gynecology,  pp.  291  ff. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  23 

from  consideration  as  ethically  rejected.  The  individual  differences 
are  so  great  that  no  rule  can  be  laid  down  as  to  the  measure  of 
temperance  in  marital  intercourse.  Good  sense  in  normal  physical 
conditions  is  a  fairly  safe  guide,  and  in  morbid  states  of  health  a 
physician  should  be  consulted. 

Precocious  sexual  intercourse  and  illegitimacy. — The  sexual 
appetite  awakens  with  puberty,  especially  in  boys ;  long  before 
knowledge,  experience,  and  reason  provide  the  moral  nature  with 
motives  for  self-control  and  inhibition  of  impulse  to  gratification. 
The  writer,  as  a  member  of  the  management  of  a  refuge  for  young 
girls,  is  compelled  to  learn  of  frequent  cases  where  the  poor  crea- 
tures become  mothers  without  being  aware  of  the  dangers,  miseries, 
and  disgrace  to  which  they  expose  themselves.  It  is  incredible  to 
a  person  reared  wholly  in  a  normal  family  life  that  there  should  be 
so  many  victims  of  ignorance  and  parental  neglect.  In  a  certain 
number  of  instances  mothers  deliberately  corrupt  their  own  daugh- 
ters and  hire  them  out  to  vice  before  conscience  has  emerged.3 

Section  2.  Venereal  diseases,  especially  gonorrhea  and  syphi- 
lis.— It  will  be  sufficient  for  our  purpose  to  present  medical  authority 
in  relation  to  the  two  most  important  and  dangerous  diseases  which 
begin  in  the  irregular  and  immoral  relations  of  prostitution,  but 
which  are  communicated  also  to  innocent  persons  by  various  modes 
of  contact.  The  two  most  distinctive  of  these  diseases  are  gonorrhea 
and  syphilis. 

Dr.  William  Osier,  in  a  recent  article  on  preventive  medicine, 
describing  the  infectious  diseases  which  are  the  greatest  scourges 
to  the  human  race,  such  as  cholera,  yellow  fever,  smallpox,  pneu- 
monia, tuberculosis,  leprosy,  etc.,  says  of  the  group  of  venereal 
diseases : 

These  are  in  one  respect  the  worst  of  all  we  have  to  mention,  for  they 
are  the  only  ones  transmitted  in  full  virulence  to  innocent  children  to  fill 
their  lives  with  suffering,  and  which  involve  equally  innocent  wives  in  the 

misery  and  shame Physicians  and  the  public  have  each  solemn  duties 

in  this  matter.4 

3  Antonio  Marro,  La  pubcrte,  chap.  xxi. 

*  Cf.  Dr.  Prince  Morrow,  in  a  pamphlet  of  the  American  Society  of  Sani- 
tary and   Moral   Prophylaxis. 


24  THE  EIGHTH  YEARBOOK 

Gonorrheal — The  cause  of  gonorrhea  is  a  micro-organism  dis- 
covered by  Neisser  in  1879. 

The  modern  period  of  our  knowledge  of  gonorrhea  dates  from  the  dis- 
covery of  the  gonococcus.  At  the  present  day  we  recognize  that  the  gono- 
coccus  is  the  sole  pathogenic  agent  of  gonorrhea  in  men  and  women,  and 
that  the  source  of  the  infection  is  in  the  immense  majority  of  cases  a 
chronic  or  latent  gonorrhea.8 

As  to  the  effects  of  this  disease  we  again  quote  from  the  same 
author  (p.  83)  : 

Instead  of  gonorrhea  being  limited  to  the  genito-urinary  tract,  as  was 
formerly  supposed,  its  morbid  action  is  now  recognized  as  being  much  more 
extensive,  not  infrequently  radiated  to  important  visceral  organs.  As  the 
result  of  modern  investigations  it  may  positively  be  affirmed  that  the  gonococ- 
cus is  susceptible  of  being  taken  up  by  the  blood  vessels  and  lymphatics  and 
that  it  may  affect  almost  every  organ  of  the  body.  The  premerential  infection 
is  directed  to  the  serous  structures  of  the  body.  Staining  and  culture 
experiments  have  demonstrated  its  presence  not  only  in  the  ovaries,  tubes, 
and  peritoneal  cavity,  which  it  reaches  through  progressive  invasion  of  the 
intermediate  membranes,  but  also  in  the  brain  and  cord,  the  endocardium, 
the  pleura,  the  liver,  spleen,  kidneys,  the  joints  and  tendon  sheaths,  and 
periostea,  to  which  it  is  carried  by  the  blood  vessels  and  through  the  peri- 
pheral capillaries  to  the  skin. 

The  number,  variety,  and  gravity  of  these  systemic  localizations  have  led 
to  the  serious  consideration  of  the  question  whether  gonorrhea  is  not  to  be 
classed  as  a  constitutional  affection — whether  these  remote  effects  are  to  be 
considered  as  only  occasional  and  exceptional  metastatic  complications,  or 
whether  there  does  not  actually  exist  in  all  cases  a  latent  infection  which 
is  only  manifest  by  those  systemic  localizations  in  grave  cases  or  in  indi- 
viduals specially  predisposed. 

As  to  the  effects  of  gonorrhea  on  woman  we  quote  from  Morrow 
again  (p.  172)  : 

All  observation  shows  that  pregnancy  is  the  worst  thing  that  can  happen 
to  a  woman  suffering  from  cervical  gonorrhea.  It  is  equivalent  to  pre- 
paring the   soil   for  the  culture   bed   of   dangerous   seed   which   might  not 

6  We  cite  the  important  work  of  the  distinguished  physician,  Dr.  Prince 
Morrow,  Social  Disease  and  Marriage  (1904).  But  several  other  important 
works  have  been  consulted,  among  them  .  Medical  Gynecology,  by  Dr.  H.  A. 
Kelly  (1908). 

8  Morrow,  op.  cit.,  p.  85. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  2$ 

otherwise  find  conditions  favorable  for  their  germination  and  growth.  If 
the  woman  becomes  pregnant,  it  may  terminate  in  abortion  or  premature 
accouchement.  At  best  she  will  probably  produce  but  one  child,  which  is 
fated  to  undergo  during  its  passage  into  the  world  inoculation  with  gonococci 
which  may  destroy  the  eyes,  and  with  what  consequences  to  the  mother? 
We  have  seen  that  gonorrheal  germs  become  multiplied  and  exalted  in 
virulence  by  their  cultivation  in  the  lochial  fluid.  They  rapidly  invade  the 
body  of  the  uterus,  ascend  to  the  annexial  organs,  with  all  the  consequences 
of  salpingitis,  oophoritis,  peritonitis,  etc.  The  essential  condition  of  cure 
is  that  it  should  be  seen  in  the  early  stage,  before  infection  of  the  uterus 
and  annexial  organs  takes  place.  When  it  reaches  the  appendages  the 
general  opinion  is  that  it  is  incurable  except  by  radical  operation. 

A  German  physician,  Dr.  Max  Gruber,  tells  of  a  young  woman 
known  in  his  practice,  who  went  on  a  wedding  journey  to  Rome  a 
blooming  bride  and  returned  broken  and  withered.  The  bride- 
groom had  taken  gonorrrhea  and  infected  her.  The  doctor  adds 
in  justifiable  wrath,  "a  man  who  consciously  acts  like  that  is  a 
damned  monster."    He  adds  : 

But  most  men  do  not  imagine  that  they  are  affected  by  gonorrhea,  do 
not  imagine  that  they  are  to  blame  when  the  wife  quickly  begins  to  grow 
ill  and  sink  after  marriage,  and  they  believe  they  have  had  an  invalid  wife 
hung  on  their  necks.  The  poor  suffering  woman  must  listen  to  reproaches 
and  she  grieves  at  heart  that  her  sickness  is  a  trouble  to  her  dear  spouse ! 
How  are  such  terrible  misfortunes,  such  errors  possible?"7 

The  offspring  of  the  mother  who  suffers  from  gonorrhea  is 
frequently  infected  and  caused  to  suffer.  Who  that  is  capable  of 
remorse  or  pity  would  refuse  to  be  turned  away  from  sexual  vice 
by  such  a  description  of  fact  as  that  given  by  physicians  ? 

The  child  in  its  passage  through  the  maternal  parts  is  compelled  to 
undergo  a  veritable  baptism  of  virulence.  In  the  course  of  its  passage  the 
face  of  the  child,  and  especially  the  eyes,  are  liable  to  be  soiled  with  the 
uterine,  vaginal,  and  vulvar  liquids  containing  gonoccocci.  The  opening  of 
the  eyes  of  the  infant,  occurring  as  a  rule  when  the  child  comes  into  the 
world,  permits  the  penetration  of  the  secretions  into  the  conjunctival  sac. 
The  gonococci  find  in  the  delicate  mucosa  of  the  eyes  a  favorable  soil  for 

inoculation After  birth  the  infectious  secretion  may  be  carried  into 

the  eyes  through  the  intermediary  of  sponges,  wash-cloths,  or  by  the  fingers 

7  Die  Prostitution  vom  Standpunkte  der  Sozialhygiene  aus  betrachtet,  Vienna, 
1905. 


26  THE  EIGHTH  YEARBOOK 

of  the  accoucheur  or  nurse.     When  one  eye  remains  uninfected,  it  may  be 
inoculated  with  the  purulent  secretion  of  the  other. 

It  is  estimated  that  from  10  to  30  per  cent,  of  all  blindness  is  caused  by 
gonorrheic  infection.  Of  all  causes  of  blindness,  purulent  conjunctivitis  is 
the  most  powerful  factor.  According  to  Neisser  there  are  in  Germany  at 
the  present  time  30,000  blind  persons  whose  loss  of  sight  is  due  to  gon- 
orrheal ophthalmia.  In  many  institutions  for  the  blind  no  fewer  than  60 
per  cent,  of  the  inmates  have  lost  their  sight  from  gonorrheal  infection.  In 
the  institutions  of  Paris  the  percentage  is  estimated  at  46,  Jullien  says  80 
per  cent.;  in  Switzerland,  20;  in  Breslau,  13;  in  this  country,  from  25  to  50. 

As  to  frequency  of  occurrence  Morrow  (p.  112)  declares: 
In  the  report  of  the  Committee  of  Seven,  which  records  1,941  cases  of 
gonorrhea  in  women  occurring  in  private  practice  in  this  city  [New  York] 
in  one  year,  there  were  found  265  children  with  purulent  ophthalmia.  In 
the  same  year  there  were  found  in  one  of  the  eye  hospitals  of  this  city  136 
cases  of  purulent  ophthalmia. 

Various  mitigating  and  preventive  means  are  known  and  used 
by  physicians,  antiseptic  washes,  treatment  of  the  eyes  (Crede 
method)  of  the  infant;  yet  even  now  many  children  suffer  blindness 
from  maternal  infection.  "At  the  present  day  in  Germany  gon- 
orrhea causes  each  year  about  600  cases  of  blindness  in  the  new- 
born." 

The  dangers  of  purulent  conjunctivitis  from  maternal  infection  are  not 
limited  to  the  child.  Nothing  is  more  infectious  than  ophthalmia  neona- 
torum. It  often  happens  that  the  attendants,  the  nurse,  or  the  members  of 
the  family  are  infected,  and  it  is  to  be  observed  that  while  the  infection 
may  be  comparatively  benign  in  the  infant  and  yield  readily  to  the  Crede 
method,  with  complete  conservation  of  the  integrity  of  the  sight,  the  infec- 
tion transmitted  to  the  attendants  most  often  results  in  a  virulent  inflamma- 
tion which  may  entirely  destroy  the  eyes.8 

Further,  we  must  consider  the  dangers  of  contact  and  diffusion 
of  this  dread  disease  even  among  the  innocent. 

The  virus  of  gonorrhea  may  be  transferred  by  means  of  any  indifferent 
object  upon  which  it  has  been  deposited  and  inoculated  when  brought 
into  contact  with  a  mucous  surface  susceptible  to  its  action. 

Numerous  well-authenticated  cases  of  water-closet  infection  have  been 
recorded.  Rossolimos  cites  cases  in  which  it  was  derived  from  the  night- 
vase,  towels,  etc.8 

8  Morrow,  op.  cit.,  p.  116.  '  Ibid. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  27 

Douches,  tubes,  fingers,  thermometers,  towels,  sponges  may  be  the 
medium  of  transmitting  the  virus.  One  of  these  classes  of  con- 
tagion is  called  from  its  localization  "vulvovaginitis."  The  inno- 
cent victims  of  this  form  of  contagion  are  usually  children  from 
two  to  six  years  of  age.  It  may  be  present  in  the  newborn  or  at  any 
age  below  puberty.  In  the  report  of  the  Committee  of  Seven  there 
were  found  218  cases  of  vulvovaginitis  in  private  practice  in  New 
York  City  among  1,941  cases  of  gonorrhea  in  women. 

It  [vulvovaginitis]  has  been  found  in  hospitals  for  children  to  be  one 
of  the  most  insidious  and  persistent  infections,  and  one  of  the  most  difficult 
to  stamp  out,  with  which  physicians  have  to  deal.10 

This  statement  is  confirmed  by  facts  furnished  the  writer  by  Dr. 
W.  A.  Evans,  Commissioner  of  Health  of  the  city  of  Chicago.  The 
public  bath  may  be  the  medium  of  communication.  Various  diseases 
and  disorders  may  be  caused  by  this  form  of  the  malady. 

In  respect  to  the  cure  of  gonorrhea,  it  is  very  important  for  the 
moral  teacher  to  avoid  all  statements  which  are  not  confirmed  by 
experience  and  by  medical  authority.  The  plain,  unvarnished  truth 
is  most  effective,  and  the  educator  who,  for  the  sake  of  frightening 
his  pupil  from  evil  ways,  resorts  to  falsehoods  or  even  questionable 
assertions,  loses  his  influence.  For  these  reasons  it  seems  wise  to 
set  down  here  the  conclusions  of  experts  in  respect  to  the  curability 
of  this  most  common  of  venereal  diseases. 

Taking  the  experience  of  the  leading  genito-urinary  specialists  in  this 
country  and  Europe  as  developed  by  the  results  of  the  investigations  of  the 
Committee  of  the  American  Medical  Association,  six  months  may  be 
accepted  as  the  average  duration  of  treatment  of  chronic  gonorrhea.11 

The  methods  of  cure  do  not  belong  here;  that  subject  is  in  the 
hands  of  the  medical  adviser  who  should  always  be  consulted  and 
his  counsels  faithfully  followed.     Quacks  should  be  avoided. 

The  widely  prevalent  notion  that  gonorrhea  is  a  trivial  disease,  not 
more  serious  than  an  ordinary  cold,  cannot  be  too  strongly  combated. 
Every  young  man  and  woman  should  know  its  serious  character  and  terri- 
ble posibilities,  and  the  vital  importance  of  consulting  a  reputable  physician 
at  the  earliest  possible  moment  after  gonorrheal  infection  is  suspected.12 

10  Dr.  J.  M.  Dodson.  u  Ibid. 

12  Morrow,  op.  cit.,  p.  86. 


28  THE  EIGHTH  YEARBOOK 

This  judgment  of  a  distinguished  physician  has  been  enforced 
and  emphasized  by  numerous  other  medical  men  who  have  been  con- 1 
suited  in  the  preparation  of  this  chapter. 

Gonorrhea  frequently  unfits  a  young  man  for  marriage  and 
makes  him  a  plague  and  a  curse  to  wife  and  children.  This  is  evi- 
dently a  serious  part  of  our  problem.  The  danger  of  communi- 
cating a  dreadful  and  destroying  disease  to  an  innocent  bride  is 
appalling  to  any  man  who  has  any  sense  of  honor,  moral  responsi- 
bility, or  religion  remaining  in  him.  Physicians  insist  upon  extreme 
caution.  Gonorrhea  is  sometimes  cured,  but  the  gonococci  may 
survive  in  the  system  long  after  the  cure  seems  to  be  complete. 
Morrow  quotes  the  authority  of  Janet: 

I  would  demand  an  entire  year  without  secondary  infection.  Even  at 
the  risk  of  being  called  a  pessimist,  I  would  impose  this  delay  upon 
gonorrheics.  The  enormous  number  of  matrimonial  uterine  affections  shows 
that  heretofore  we  have  been  too  indulgent  in  this  regard.  Metritis,  sal- 
pingitis, and  grave  operations  are  the  future  of  these  unfortunate  wives  who 
had  hoped  to  find  happiness  in  marriage.  It  is  time  to  react,  to  consider 
gonorrhea  as  at  least  equal  to  syphilis  from  the  point  of  view  of  conjugal 
relations. 

A  quotation  from  Jullien  (Blenorrragie  et  manage,  cited  by 
Morrow,  op.  cit.,  p.  169)  is  apt: 

When  the  responsibilities  are  well  examined  it  is  often  to  the  negli- 
gence or  ignorance  of  the  doctor  they  must  be  ascribed.  If  he  has  made  an 
insufficient  examination,  if  he  has  been  satisfied  with  a  rapid  inspection,  or 
if  deceived  by  false  traditions,  he  has  advised  marriage  in  order  to  cure  the 
gleet,  he  alone  is  guilty.  To  tabulate  all  the  calamities  which  follow  this 
fatal  carelessness  would  be  to  write  the  endless  martyrology  of  marriage, 
the  saddest  page  I  know. 

Most  authorities  maintain  that  the  disease  may  be  eradicated  by  per- 
sistent treatment  conducted  over  a  long  period  of  time.  Every  individual 
who  has  once  had  gonorrhea  should  be  assumed  to  be  infected  until  the  con- 
trary has  been  proved The   poor,   half-cured  victims   of  gonococcus 

infection  are  a  menace  to  the  community  and  a  stain  on  the  fair  name  Oi 
the  medical  profession.13 

One  branch  of  this   investigation   has   special   interest   for   all 

"Dr.  H.  A.  Kelly,  Medical  Gynecology,  pp.  362,  373- 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS 


2Q 


teachers,  especially  to  those  who  give  instruction  in  special  classes 
and  schools  for  the  blind.14 

REPORTS  FROM  SCHOOLS  FOR  THE  BLIND,  1907 


Schools  for  the  Blind 


No.  of  New 
Admissions 


No.  Blind 
from  Opth. 
Neonatorum 


Percentage 


New  York  State  School  for  the  Bind 

Penn  Inst,  for  the  Blind,  Overbrook,  Pa. 

Institute  for  the  Blind,  Austin,  Tex 


13 

27 


3°-7 
33-33 


(Not  definite — -about  10.) 


Perkins  Institute  and  Mass.  School  for  the  Blind 

Colorado  School  for  the  Blind,  Colorado  Springs 

Western   Penn.  Inst,  for  Blind,  Pittsburg,  Pa. ,  (Percentage 

of  total  number  in  school,  31.37.) 

Missouri  School  for  the  Blind,  St.  Louis 

State  Board  of  Education  for  the  Blind,,  Hartford,  Conn., 

(since  creation  of  board  in  1893,  34. 74.) 

State  School  for  the  Blind,  Columbus,  Ohio  (Reduction  of 

usual  percentage  and  as  low  as  at  any    time    in    last    12 

years) 

Maryland  School  for  the  Blind  (percentage  of  total  number  in 

school  in  1905,  25.50) 

Ontario  Inst,  for  Blind,  Brantford,  Ont.  (Percentage  of  total 

number  in  school,  24. 7) 


30.00 
42.8 

28.57 
31-57 

12.50 

983 
30-77 
21.74 


The  average  then  of  the  new  admissions  in  the  fall  of  1907  to  the  ten 
schools  in  which  exact  records  were  kept  and  representing  eight  states  and 
the  province  of  Ontario  was  25.21  per  cent.,  or  one-quarter  of  the  whole 
number,  needlessly  blind. 

That  these  are  not  unusual  results  is  shown  by  the  following  report 
from  the  Pennsylvania  School  for  the  Blind  for  the  past  eight  years. 

Per  cent.  Per  cent. 

1900 11  out  of  25=44      1904 15  out  of  56  =  25.00 

1901 10  out  of  26  =  35       1905 21  out  of  42  =  50.00 

1902 9  out  of  39  =  23      1906 12  out  of  38  =  31 .00 

1903 14  out  of  50  =  28      1907 9  out  of  27  =  33.33 

The  average  percentage  of  these  eight  years  is  33.36  per  cent,  of  the 
whole  number  admitted.  As  this  enormously  high  proportion  of  blindness 
due  to  opthalmia  neonatorum  is  found  in  states  maintaining  the  highest 
standards  of  medical  education  and  general  sanitation,  there  is  no  doubt 
whatever  that  when  exact  statistics  can  be  obtained  at  least  as  large  a 
percentage  due  to  this  cause  will  be  found  elsewhere  throughout  the  country. 

Widespread  knowledge  concerning  ophthalmia  neonatorum  and 

its  dangers  is  of  vital  social  importance.    Helen  Keller  voices  a  very 

proper  public  sentiment  when  she  says: 

"The  problem  of  prevention  should  be  dealt  with   frankly.     Physicians 
14  See   "Report  of  the   Committee   on    Ophthalmia   Neonatorum,"  Journal   of 

the  American  Medical  Association,  May  23,  1908,  Vol.  I,  pp.  1745-49  (Dr.  F.  Park 

Lewis,  Chairman). 


30  THE  EIGHTH  YEARBOOK 

should  take  pains  to  disseminate  knowledge  needful  for  a  clear  under- 
standing of  the  causes  of  blindness.  The  time  for  hinting  at  unpleasant 
truths  is  past.  Let  us  insist  that  the  states  put  into  practice  every  known 
and  approved  method  of  prevention  and  that  physicians  and  teachers  open 
wide  the  doors  of  knowledge  for  the  people  to  enter  in.  The  facts  are  not 
agreeable  reading.  Often  they  are  revolting.  But  it  is  better  that  our 
sensibilities  should  be  shocked  than  that  we  should  be  ignorant  of  facts  on 
which  rest  sight,  hearing,  intelligence,  morals,  and  the  life  of  the  children  of 
men.  Let  us  do  our  best  to  rend  the  thick  curtain  with  which  society  is 
hiding  its  eyes  from  the  unpleasant  but  needful  truths. 

Syphilis. — We  must  tread  this  via  dolorosa  still  further  in  the 
interest  of  truth  and  humanity,  and  add  a  brief  account  of  another 
pest  of  mankind,  slayer  of  multitudes,  itself  primarily  the  issue  of 
immorality.  The  source  of  this  disease  is  a  micro-organism,  and 
the  malady  arises  primarily  from  sexual  intercourse  with  prosti- 
tutes, although  it  is  also  communicated  to  innocent  persons.  Let 
us  mass  our  evidence  in  relation  to  the  causes  and  effects  of  this 
disease  of  vice. 

While  syphilis  is  a  less  prevalent  disease  than  gonorrhea,  it  is  much 
more  prolific  in  sources  and  modes  of  contagion,  and,  in  addition,  is  sus- 
ceptible of  hereditary  transmission.  When  syphilis  is  introduced  into  mar- 
riage it  may  become  the  origin  of  many  innocent  infections.  Not  only  the 
wife  and  the  children  may  be  contaminated,  but  the  syphilitic  infant  may 
infect  the  nurse  or  other  members  of  the  family,  and  the  nurse  may  in 
turn  infect  her  husband  and  her  own  children.  Veritable  endemics  of 
syphilis  have  originated  in  this  way.  It  is  this  quality  of  expansiveness, 
this  capacity  of  morbid  irradiation  through  family  and  social  life,  that 
gives  to  syphilis  its  superior  significance  as  a  social  danger.15 

Syphilis  sterilizes  and  so  defeats  the  social  purpose  of  marriage. 

The  function  of  marriage  is  to  create  life ;  the  action  of  syphilis  is  to 
damage  or  destroy  life.  While  syphilis  may  not  materially  affect  the 
capacity  for  sexual  intercourse  nor  impair  the  power  of  procreation,  it 
renders  the  one  dangerous  by  infection,  the  other  deadly  through  inheritance. 

Even  when  syphilis  does  not  destroy  the  product  of  conception  it 
transmits  to  the  offspring  a  defective  organization — the  infant  comes  into 
the  world  a  blighted  being,  lacking  in  development  and  physical  stamina  and 
stamped  with  inferiority.  Syphilis  is  thus  not  only  a  factor  of  depopula- 
tion, but  a  cause  of  degeneration  of  the  race. 

15  Morrow,  op.  cit.,  pp.  181,  ff. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  31 

Now,  syphilis  introduced  into  marriage  often  strikes  the  death  knell  of 
such  hopes ;  it  is  destructive  of  the  mutual  love  and  esteem  which  should 
form  the  basis  of  marriage.  Syphilis  distils  a  double  venom;  it  poisons 
not  only  the  health  but  the  happiness  of  the  household.  It  carries  in  its 
train  not  only  physical  woes,  but  social  misery;  often  disunion  and  divorce. 

What  husband  can  hope  to  retain  the  love  and  esteem  of  the  wife  whom 
he  has  dishonored  with  a  shameful  disease;  of  the  mother  in  whose  child 
he  has  infused  the  foul  taint  of  the  prostitute,  which  dies  before  being 
born,  or  comes  into  the  world  an  object  of  disgust  and  horror?  If  he  be  a 
man  of  conscience  and  sensibility,  what  remorse  he  must  suffer  from  his 
sense  of  guilty  responsibility  for  the  ruin  he  has  wrought ! 

These  pathological  consequenecs  and  the  social  miseries  they  engender 
are  by  no  means  exceptional  or  uncommon.  They  are  the  natural  expres- 
sion of  the  disease,  the  sequence  of  cause  and  effect,  almost  inevitable  under 
I  the  conditions  created  by  the  marriage  relation.  Their  frequency  is  far 
from  being  appreciated  by  the  laity  or  even  the  general  medical  practitioner. 
Syphilis  wears  the  protective  mantle  of  shame,  of  secrecy,  and  silence,  and 
its  ravages,  physical  as  well  as  social,  are  concealed  from  the  public  view.16 

The  conclusions  of  a  long  and  technical  argument,  fortified  by 
citations  from  the  highest  European  and  American  medical  author- 
ities are  thus  summarized  by  Dr.  Morrow : 

RESUME    AND    CONCLUSIONS     (iN    RESPECT    TO    SYPHILIS) 

From  this  study  of  prematrimonial   syphilis  the   following  conclusions 
may  be  formulated : 

1.  The  two  qualities  of  syphilis  which  emphasize  its  important  relations 
with  marriage  are  its  contagiousness  and  susceptibilty  of  hereditary 
transmission. 

2.  These  qualities  are  not  impressed  upon  the  syphilitic  organism  indefi- 
nitely; as  syphilis  advances  in  its  evolution  the  virulent  principle  gradually 
becomes  extinguished. 

3.  Specific  treatment  also  exerts  a  marked  attenuating  and  corrective 
influence  upon  the  diathesis. 

4.  Syphilis  does  not  therefore  constitute  an  absolute  permanent  obstacle 
to  marriage ;  it  is  only  a  temporary  bar  which  may  be  removed  by  time 
and  treatment. 

5.  The  decision  of  the  question  of  the  admissibility  to  marriage  of  a 
man  with  syphilis  or  with  syphilitic  antecedents  imposes  a  grave  responsi- 
bility upon  the  physician. 

6.  The  physician  should  consider  the  proposed  marriage  solely  as  a  sani- 
16  Morrow,  op.  cit.,  pp.  182,  183. 


32  THE  EIGHTH  YEARBOOK 

tary  problem,  the  only  correct  solution  of  which  is  that  the  man  should  not 
marry  so  long  as  he  is  capable  of  infecting  his  wife  or  transmitting  his 
disease  to  his  children. 

7.  The  elements  which  serve  for  the  determination  of  this  question  are 
based  partly  upon  our  knowledge  of  the  pathological  laws  of  the  disease 
and  largely  upon  the  results  of  clinical  experience. 

8.  The  division  of  syphilis  into  secondary  and  tertiary  periods,  or  that 
based  upon  anatomical  forms  and  processes,  does  not  furnish  a  safe  cri- 
terion for  determining  the  contagious  or  non-contagious  character  of  the 
lesions. 

9.  The  chronological  completion  of  the  secondary  stage  does  not  always 
mark  the  definite  disappearance  of  the  virulent  principle;  clinical  experience 
shows  that  the  late  lesion  may  be  exceptionally,  but  none  the  less  certainly, 
the  source  of  contagion. 

10.  The  precise  date  in  the  evolution  of  the  diathesis  when  the  syph- 
ilitic organism  undergoes  that  radical  transformation  which  marks  the  limit 
of  its  contagious  or  transmissive  power  does  not  admit  of  mathematical 
expression. 

11.  It  is  probable  that  this  limit  varies  in  different  cases  and  that  many 
circumstances  contribute  to  advance  or  defer  it. 

12.  The  type  of  the  disease,  the  constitutional  peculiarities  of  the 
patient,  the  presence  or  absence  of  certain  conditions  which  are  recognized 
as  factors  of  gravity  in  syphilis,  the  treatment  employed,  all  exert  a  modi- 
fying influence. 

13.  All  these  elements  should  be  taken  into  consideration  in  deciding 
upon  the  admissibility  of  a  syphilitic  man  to  marriage ;  each  case  should 
be  studied  upon  its  individual  merits. 

14.  The  advanced  age  of  the  diathesis,  a  prolonged  immunity  from 
specific  accidents  and  sufficient  specific  treatment  are  the  surest  guarantees 
of  safety. 

15.  The  arbitrary  designation  of  a  period  of  three  or  even  four  years 
as  perfectly  safe  for  a  syphilitic  man  to  marry,  with  or  without  treatment, 
and  irrespective  of  the  character  of  the  diathesis  is  unwarranted  by  science 
or  the  teachings  of  experience. 

16.  While  in  the  immense  majority  of  cases  the  contagious  activity  of 
syphilis  and  its  hereditary  transmissibility  cease  after  the  third  or  fourth 
year,  yet  well-authenticated  observations  prove  in  the  most  positive  man- 
ner that  these  qualities  sometimes  continue  much  longer,  and  may  be  mani- 
fest in  the  fifth  or  sixth  year  of  the  disease,  and  even  later. 

17.  The  aptitude  of  syphilitic  parents  to  procreate  diseased  children  may 
persist  after  the  cessation  of  all  specific  manifestations ;  the  contagious  state 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  33 

of  syphilis  is  not,  therefore,  the  exact  measure  of  the  duration  of  hereditary 
influence ;   this  is   especially  true  of  maternal  heredity. 

18.  The  curative  influence  of  specific  treatment  in  causing  to  disappear 
the  organic  lesions  as  well  as  the  functional  disorders  created  by  the 
syphilitic  virus  is  well  established. 

19.  While  the  preventive  action  of  specific  treatment  is  less  pronounced 
than  its  curative  action,  it  is  hardly  conceivable  that  a  treatment  which 
exhibits  such  incontestable  virtue  in  causing  the  accidents  of  syphilis  to 
disappear  should  not  be  capable  of  dominating  and  destroying  the  diathesis, 
if  sufficiently  prolonged. 

20.  The  value  of  specific  treatment  in  suppressing,  holding  in  obeyance, 
and  finally  correcting  the  hereditary  influence  of  syphilis  may  be  accepted 
as  well  established  by  clinical  experience. 

21.  Clinical  observation  shows  that  when  there  is  a  cessation  of  all 
specific  manifestations  after  the  completion  of  the  secondary  stage,  and  this 
exemption  is  prolonged  during  a  period  of  twelve  or  eighteen  months,  they 
are  not  liable  to  recur. 

22.  When  the  syphilitic  diathesis  has  been  subjected  to  the  double 
depurative  action  of  time  and  treatment  during  a  period  of  four  years,  in 
the  vast  majority  of  cases  it  is  scientifically  safe  for  the  syphilitic  to  marry. 

23.  This  rule  is  based  upon  a  calculation  of  probabilities.  Medical  cer- 
tainty is  not  mathematical  certainty,  and  a  longer  period  of  delay  would 
afford  additional  guarantees  of  safety  to  the  wife  and  prospective  children. 

24.  In  deciding  upon  the  fitness  of  a  syphilitic  man  for  marriage  the  risks 
to  the  personal  health  of  the  prospective  husband  from  his  disease  should 
always  be  considered. 

25.  A  menacing  character  of  the  diathesis,  and  especially  the  existence 
and  history  of  certain  symptoms  which  point  to  the  implication  of  the 
brain,  nervous  system,  or  other  important  organs  constitute  an  express, 
permanent  contraindication  to  marriage." 

To  fortify  the  argument  further  the  words  of  Dr.  H.  A.  Kelly 
may  here  be  cited  and  reference  is  made  to  his  discussion: 

Two  fundamental  characters,  contagiousness  and  susceptibility  of  heredi- 
tary transmission,  give  to  syphilis  an  altogether  special  importance  in  rela- 
tion to  marriage In  addition,  hereditary  syphilis  undoubtedly  creates 

a  terrain  or  soil  favorable  for  the  reception  and  germination  of  tubercle 
bacilli  and  perhaps  other  bacilli.  It  does  this  by  impoverishing  the  organism 
and  diminishing  the  capacity  of  resistance  against  microbic  invasion. 

Syphilis    is   the   only   disease   transmitted   in    full   virulence   to   the   off- 

17  Morrow,  op.  cit.,  p.  258. 


34  THE  EIGHTH   YEARBOOK 

spring,  killing  them  outright  or  blighting  their  normal  development.  Fro 
the  view-point  of  race  perpetuation  syphilis  is  antagonistic  to  all  that  th« 
family  represents  in  our  social  system.  The  social  aim  of  marriage  is  noi 
simply  the  procreation  of  children,  but  of  children  born  in  conditions  ol 
vitality,  health,  and  physical  vigor.  The  effect  of  syphilis  is  so  to  vitiate  the1 
procreative  process  as  to  produce  abortions,  or  else  a  race  of  inferior  beings  j 
endowed  with  defects  and  infirmities  and  unfit  for  the  struggle  of  life.  Ill 
is  this  pernicious  effect  of  syphilis  upon  the  offspring  which  gives  to  the 
disease  a  dominant  influence  as  a  factor  in  the  degeneration  and  depopula-i 
tion  of  the  race. 

Apart  from  its  hereditary  risks,  the  important  relations  of  syphilis  with 
marriage  are  emphasized  by  its  quality  of  contagiousness.  Owing  to  its 
multitudinous  modes  of  contagion,  syphilis,  introduced  into  marriage,  often 
becomes  the  origin  of  numerous  innocent  infections  which  are  communicated 

in  the  ordinary  relations   of   family  and   social   life Even   after  the 

dangers  of  syphilis,  from  the  standpoint  of  its  contagiousness  and  trans 
missibility  by  inheritance,  have  been  silenced  by  time  and  treatment,  a 
syphilitic  man  may  be  incapacitated  for  marriage  by  reason  of  his  personal 
risks  from  the  disease.  Unfortunately,  syphilis  often  yields  a  late  harvest 
of  tabes,  general  paralysis,  and  other  lesions  of  the  general  nervous  system 
— affections  for  the  most  part  disabling  and  incurable — which  may  ruin 
the  patient's  health  and  entirely  incapacitate  him  for  the  responsible  position 
of  the  head  and  support  of  a  family.  The  existence  of  such  conditions 
constitutes  an  express  permanent  contraindication  to  marriage.18 

It  is  the  fixed  purpose  of  the  author  of  this  volume,  as  a  layman, 
to  set  down  no  fact  which  does  not  come  directly  from  a  compe- 
tent medical  man  of  high  standing.  The  illustrations  which  fol- 
low are  simply  a  reprint  of  Circular  No.  3,  on  "Family  Protection," 
prepared  by  Dr.  W.  T.  Belfield,  secretary  of  the  Chicago  Society  of 
Social  Hygiene,  and  an  eminent  authority  in  this  field.19  The  cases 
were  furnished  him  by  several  physicians.  It  requires  no  comment. 
Its  laconic  brevity  brings  out  the  tragedies  implied  without  waste 
of  words,  and  it  fortifies  the  statements  already  made. 

The  first  step  toward  such  protection  is  general  enlightenment  as  to 
the  actual  frequency  of  such  tragedies  among  the  newly  married.  To  this 
end  the  medical  members  of  this  society  were  requested  to  furnish  instances 
of  such  disasters  which  they  had  personally  observed.     Only  a  few  of  the 

18  Medical  Gynecology,  pp.  419  ff. 

19  See  also  his  Man  and  Woman,  p.  87. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  35 

many  responses  can  be  summarized  in  this  leaflet.  These  illustrate  the 
most  frequent  tragedies  resulting  from  the  contamination  of  the  family 
through  venereal  disease,  namely: 

a)  The  loss  of  motherhood,  even  of  life  itself. 

b)  The  mutilation  of  the  wife  by  surgery  to  preserve  her  life. 

c)  The  loss  of  eyesight  in  the  new-born  infant. 

d)  The  loss  of  pecuniary  support  through  the  disability  of  the  husband. 

1.  A  girl  twenty-two  years  old  married  a  man  of  twenty-six.  About  a 
month  after  the  wedding  the  bride  was  confined  to  her  bed  for  several  days 
with  severe  pains  in  the  pelvic  region,  accompanied  with  fever  (peritonitis)  ; 
and  she  remained  a  semi-invalid  from  that  time.  On  her  return  from  their 
European  trip  five  months  later  she  was  brought  to  me  for  examination. 
The  cause  of  her  illness  was  found  in  a  gonorrhoeal  abscess  of  each 
fallopian  tube,  which  rendered  her  an  invalid  as  well  as  sterile.  Careful 
treatment  produced  but  slight  improvement.  Finally  a  surgical  operation  was 
performed  and  the  tubes  removed.  This  greatly  improved  her  health 
though  she  is,  of  course,  permanently  barren.  The  husband  admitted  that  he 
had  twice  contracted  a  mild  gonorrhoea  while  at  college  years  before,  but 
considered  himself  cured.  Examination  revealed  the  germs  of  this  disease 
in  him. 

2.  A  bride  eighteen  years  old  came  to  my  office  with  her  mother  two 
weeks  after  her  wedding.  She  was  suffering  from  newly  acquired  gon- 
orrhoea. After  eight  weeks  of  constant  treatment,  she  was  apparently 
well.     Her  husband  had  lived  "like  other  men." 

3.  Several  years  ago  there  came  under  my  care  a  case  that  I  can  never 
forget.  The  patient  was  a  bride  twenty-two  years  old,  a  beautiful  woman 
of  excellent  family.  She  was  suffering  from  gonorrhoea  contracted  from 
her  husband,  who  had  supposed  himself  cured  before  the  wedding.  An 
operation,  which  offered  the  only  chance  of  saving  her  life,  was  performed. 
All  went  well  for  a  few  days.  Her  husband,  who  had  been  constantly  with 
her,  was  called  away  on  urgent  business.  The  patient  suddenly  became 
worse  and  died  before  his  return. 

4.  A  man  with  gonorrhoea  of  fifteen  months'  duration,  applied  for 
treatment  with  the  request  to  cure  him  in  six  weeks,  as  he  was  bound  to 
get  married  at  the  end  of  that  time.  After  examination  the  patient  was 
warned  that  he  could  hardly  expect  to  be  cured  by  that  time.  At  the  end 
of  six  weeks  permission  to  marry  was  refused.  The  patient  disobeyed  and 
married  the  heiress  to  a  considerable  estate.  She  became  contaminated 
with  his  disease.  Five  months  after  the  wedding  she  was  taken  to  a  hospi- 
tal, operated  upon  for  gonorrhoeal  abscess,  and  died  two  days  after  the 
operation. 


36  THE  EIGHTH  YEARBOOK 

5.  I  am  at  present  attending  the  bride  of  a  young  man  who  thought  he 
had  recovered  before  his  wedding  from  an  attack  of  gonorrhoea.  The 
young  wife  has  gonorrhoeal  peritonitis.  She  will  doubtless  recover  but  is 
probably  permanently  sterile. 

6.  A  family  consists  of  a  father,  mother,  and  three  children;  the  father 
is  a  mechanic,  works  at  night  and  sleeps  during  the  day.  At  night  the 
mother  and  children  occupy  his  bed  without  changing  the  bedding.  The 
father  contracts  gonorrhoea,  a  druggist  prescribes  for  him  on  his  way 
home  from  work.  In  a  few  days  the  baby  develops  gonorrhoeal  inflamma- 
tion in  both  eyes,  and  a  girl  of  six  shows  the  disease  in  the  sexual  organs. 
Both  children  became  infected  from  the  bed  polluted  by  the  father. 

7.  A  married  man  while  intoxicated  contracted  gonorrhoea.  His  little 
daughter  seven  years  old,  who  slept  in  the  same  bed  with  him,  developed 
the  disease  in  both  eyes.     Careful  treatment  fortunately  saved  her  eyesight. 

8.  A  young  bride  was  infected  with  gonorrhoea  by  her  husband,  who 
supposed  himself  cured  before  marriage.  When  her  baby  came  its  eyes 
were  infected ;  and  it  was  saved  from  total  blindness  only  by  most  pains- 
taking care  by  himself  and  a  trained  nurse,  covering  a  period  of  three  or 
four  anxious  weeks.  During  the  treatment  of  the  little  one's  eyes,  in  spite 
of  care  and  warning,  the  mother's  breast  became  infected,  causing  a  pain- 
ful and  tedious  abscess. 

In  another  case,  also  of  gonorrhoeal  inflammation  of  the  young  mother, 
the  babe's  eyes  were  infected;  within  two  weeks  both  were  lost,  and  the 
child  is  totally  blind.  I  am  sure  that  the  majority  of  these  cases  are  due 
to  lack  of  knowledge  on  the  part  of  the  husband,  who  is  not  told  that  the 
disease  may  lurk  in  his  deeper  parts  long  after  it  is  outwardly  cured. 

9.  We  have  in  the  children's  department  of  the  County  Hospital  numer- 
ous cases  of  gonorrhoea  among  the  children,  especially  the  little  girls.  The 
increase  of  this  disease  in  our  children's  department  has  been  alarming 
during  the  last  two  years,  and  we  are  sometimes  unable  to  trace  the  source 
of  infection. 

10.  I  believe  it  very  conservative  to  state  that  I  see  each  week  two 
cases  of  gonorrhoea  in  newly  married  women,  the  illness  dating  from 
marriage. 

11.  E.  had  been  most  carefully  reared  coming  of  ministerial  stock  for 
generations  past;  a  young  man  to  whom  she  had  been  engaged  for  three 
years  betrayed  her.  She  came  to  us  two  months  before  her  child  was 
born  and  had  never  shown  any  signs  of  syphilis.  The  little  one,  however, 
was  diseased  when  born,  suffered  greatly  during  the  four  short  months  of 
its  life,  and  then  died,  its  little  body  gradually  becoming  decayed  from  the 
time  of  its  birth. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  37 

12.  The  most  pitiful  case  of  inherited  syphilis  I  have  known  is  a  girl 
of  eighteen  who  is  just  learning  to  spell  "cat"  and  "dog."  Her  growth 
has  been  stunted  and  her  vision  practically  destroyed  by  this  inherited 
disease;  and  though  she  has  been  helped  by  proper  treatment  she  will 
always  be  a  loser  in  the  fight  of  life. 

I  know  two  childless  women  both  of  whom  are  disabled  because  of 
gonorrhoea  contracted  from  their  husbands.  One  of  the  men  shares  the 
grief  of  his  wife  because  of  the  semi-invalidism  that  he  has  forced  upon 
her. 

13.  A  young  wife  gave  birth  to  her  first  child,  a  credit  to  the  parents. 
During  her  invalidism  the  husband  met  a  former  sweetheart,  contracted 
syphilis  from  her,  and  before  he  became  aware  of  his  own  infection,  con- 
taminated his  wife.  She  developed  syphilitic  sores  in  the  mouth,  and 
through  her  kisses  infected  the  child  with  the  disease  contracted  from  her 
husband. 

14.  A  young  man  married  two  years  after  he  had  contracted  syphilis, 
Within  a  year  his  wife  had  a  spontaneous  miscarriage,  her  child  having 
been  destroyed  by  the  taint  inherited  from  the  father.  A  year  later  she 
gave  birth  to  a  puny  child  which  bore  the  marks  of  the  same  disease. 

Soon  after  the  birth  of  this  child  the  father,  who  had  apparently 
enjoyed  good  health,  awoke  one  morning  to  find  his  right  arm  and  leg 
completely  paralyzed  and  his  ability  to  utter  words  abolished,  his  paralysis 
resulting  from  syphilitic  disease  of  the  blood  vessels  in  the  brain.  He 
gradually  regained  his  power  of  speech,  and  the  use  of  his  paralyzed  limbs, 
though  unable  to  earn  a  living  for  over  a  year.  During  this  time  the  family 
was  dependent  for  subsistence  upon  the  charity  of  relatives.  He  will  proba- 
bly have  more  trouble  from  the  same  cause. 

15.  A  young  man  who  was  on  kissing  terms  with  several  girls,  acquired 
syphilis.  Though  warned  that  he  could  communicate  the  disease  by  a  kiss, 
he  failed  to  resist  temptation,  and  implanted  the  disease  on  the  lip  of  each 
of  two  girls  of  good  family. 

16.  Six  years  after  acquiring  syphilis,  during  which  time  he  had  mar- 
ried and  begotten  a  child,  a  young  man  developed  locomotor  ataxia.  The 
physical  and  mental  disability  thereby  entailed  caused  the  loss  of  a  good 
position  and  bright  business  prospects ;  and  the  present  financial  outlook 
for  his  family  is  discouraging. 

The  majority  of  cases  of  venereal  disease  acquired  before  marriage 
fortunately  do  not  entail  such  disasters  to  wives  and  children.  Instances 
like  those  just  related  constitute  the  exceptions  rather  than  the  rule; 
nevertheless,  of  the  60,000  blind  people  in  this  country,  at  least  12,000  lost 
their    eyesight   at    birth    through    infection    of    the    eyes    with    the    venereal 


38  THE  EIGHTH  YEARBOOK 

diseases  of  the  parents.     The  cases  of  surgical  mutilation  and  of  perma- 
nent invalidism  of  wives;   of  the  barrenness  of  marriage;   of  infant  mor- 
tality before  and  after  birth;   of  destitution  through  disease  of  the  brain! 
and  nervous  system  in  the  family  bread-winner — all  these  also  are  appallingly  | 
frequent  results  of  venereal  contamination. 

It  is  therefore  apparent  that  no  man   who  has   ever  acquired  venereal 
disease   should  marry  until   he  has   secured  the   assurance   of  a  competent! 
physician  that   such  disease  has  been   eradicated.     The  difference  between! 
an  apparent  cure  and  a  real  cure  can  be  determined  only  through  expert! 
medical  examination. 

It  is  equally  apparent  that  the  disasters  to  self,  prospective  bride,  and  j 
children  which  are  entailed  by  the  venereal  diseases,  constitute  a  risk  | 
which  no  intelligent  man  should  take  merely  to  enjoy  the  animal  pleasures, 
of  promiscuous  cohabitation — pleasures  which  are  no  more  necessary  to  i 
bodily  health  than  are  the  joys  of  drunkenness.20 

The  illustrations  of  these  evil  consequences  might  be  multiplied 
indefinitely,  and  physicians  in  almost  any  large  town  or  city  can 
furnish  only  too  many  examples  in  local  experience. 

Is  prostitution  necessary  to  the  protection  of  good  women 
against  the  assaults  of  men? — The  facts  already  presented  reveal 
one  aspect  of  the  danger  to  which  upright  women,  who  are  the 
vast  majority  of  all  women,  are  exposed  in  consequence  of  the  exist- 
ence of  the  "social  evil."  Is  there  any  countervailing  advantage 
to  them  to  set  over  against  the  demonstrated  perils  and  sufferings  ? 
Does  not  every  prostitute  by  her  very  presence  excite  the  sexual 
passion  of  many  boys  and  men?  Does  she  not  win  her  bread  by 
tempting  youth?  Is  she  not  driven  by  the  pangs  of  hunger  to 
invent  arts  for  breaking  down  moral  restraints  and  the  inhibitions 
of  reason?  How  can  the  trade  of  the  harlot  protect  purity?  An 
article  on  "Education  and  the  Social  Evil"  by  Dr.  A.  W.  Sterling 
of  Atlanta,  is  summarized  in  the  Journal  of  the  American  Medical 
Association,  April  18,  1908,  p.  1306: 

Sterling  discusses  this  subject  and  arrives  at  the  conclusion  that  con- 
tinence and  pure  monogamy  are  the  western  ideals.  The  assertion  that 
prostitution  has  always  existed  and  always  will  exist — is,  in  short,  a  neces- 
sary evil — he  answers  by  pointing  out  that  those  who   advance  this  view 

20  That  venereal  diseases  inflict  injury  on  innocent  wives  and  children  may 
be  seen  in  L.  Duncan  Bulkley,  A.M.,  M.D.,  Syphilis  in  the  Innocent,  Bailey  and 
Fairchild,  New  York. 


PATHOLOGICL,  ECONOMIC,  AND  SOCIAL  ASPECTS  39 

would  be  as  quick  as  their  neighbors  to  resent  the  idea  that  any  of  their 
own  people  should  embark  in  this  necessary,  and,  according  to  themselves, 

saving    profession Prostitution,    if    necessary,    cannot    be    immoral, 

because  it  stands  to  reason  that  no  necessary  position  in  life  is  immoral. 
.  ...  If  it  is  not  necessary,  enough  has  been  said  to  show  that  its  effects 
are  so  destructive,  physically  and  morally,  that  it  is  high  time  something  is 
done  to  demolish  it. 

If  we  legalize  this  infamous  business,  where  shall  we  look  to  recruit 
the  ever-fading  ranks  of  these  poor  creatures  as  they  die  yearly  by  the 
tens  of  thousands?  Which  of  the  little  girls  of  our  land  shall  we  desig- 
nate for  this  traffic?  Mark  their  sweet  innocence  today  as  they  run  about 
in  our  streets  and  parks,  prattling  and  playing,  ever  busy  about  nothing, 
and  earth's  only  memento  of  the  angels  in  their  guilelessness.  Which  of 
them  shall  we  snatch  as  they  approach  maturity  to  supply  the  foul  mart  of 
the  insatiable  cravings  of  lust  ?  Perish  the  thought !  Again,  we  surely  would 
not  allow  the  daughters  of  our  rich  men  to  enter  our  legalized  brothels. 
The  poor  man  must  suffer  and  be  robbed  of  the  flower  or  his  family — the 
poor  man  who,  Jacob  Riis  tells  us,  has  no  appeal  beyond  the  policeman, 
and  practically  no  rights  in  our  courts.  Sherman  said  "War  is  hell,"  but 
war  is  a  sweet,  a  noble,  and  a  choice  calling  compared  with  a  life  in  this 
pit  of  iniquity.  The  only  way  out  of  the  difficulty  is  to  assert  that  the 
young  girls  naturally  love  this  debauched  life;  but  before  I  believe  that 
you  will  have  to  rob  me  of  my  experience  with  women  who,  for  the  most 
part,  began  by  being  seduced. — Dr.  H.  A.  Kelly. 

Prostitution  cannot  be  called  necessary  or  harmless. 

I  must  confess  that  I  regard  masturbation  itself  far  a  lesser  evil,  danger- 
ous and  harmful  as  it  is  for  youth  and  in  excess  also  for  adults.  At  most 
it  harms  only  the  sinner  himself,  while  those  who  use  prostitution  bear 
also  the  blame  of  helping  the  physical  ruin  of  thousands  of  unhappy 
women  who  are  driven  into  incurable  invalidism  and  early  death.  For 
almost  all  professional  prostitutes  are  gonorrheic  and  syphilitic,  and,  even 
apart  from  that,  most  of  them  by  their  irregular  mode  of  life,  abuse  of 
alcohol,  and  residence  in  prison  are  gradually  ruined.  In  England,  accord- 
ing to  Tait,  prostitutes  reach  on  the  average  only  twenty-five  years  of  age.21 

"The  sexual  necessity." — A  related  question,  on  which  there  is 
considerable  difference  of  opinion  among  physicians,  is  whether 
sexual  intercourse  is  generally  necessary  to  health.     What  is  true 

21  Dr.  Max  Gruber,  Die  Prostitution  vom  Standpunkte  der  Sozialhygiene 
aus  betrachtet,  p.  30. 


40  THE  EIGHTH  YEARBOOK 

in  this  matter  and  what,  therefore,  should  be  the  attitude  of  teach- 
ers and  counselors  of  youth  on  this  subject?  That  sexual  inter- 
course is,  for  adults,  normally  desirable  from  the  standpoint  of  indi- 
vidual health  as  well  as  for  the  existence  and  welfare  of  society 
may  be  at  once  frankly  asserted.  Celibacy  could  not  be  the  regu- 
lar mode  of  life  for  adults,  and  marriage  at  a  suitable  age  may  be 
regarded  as  best  physically  and  spiritually  for  the  vast  majority  of 
healthy  people.  But  this  does  not  mean  that  sexual  intercourse  is 
necessary,  as  breathing  and  eating  are  necessary  to  life;  nor  is  it 
fatal  and  inevitable  as  gravity,  or  as  the  involuntary  movements  of 
the  heart  muscles  or  the  rhythmic  secretion  of  the  various  glands 
of  the  body.  Nature  has  provided  a  harmless  outlet  for  the  secre- 
tions of  the  reproductive  system  without  either  masturbation  or 
illicit  sexual  intercourse.22  The  intercourse  of  the  sexes  is,  apart 
from  the  pathological  cases  of  the  insane  and  idiotic,  a  voluntary 
act.  Alcohol  temporarily  induces  a  pathological  state  when  the 
control  of  reason  and  will  is  broken. 

That  both  men  and  women  can  abstain  without  serious  injury 
to  health  is  demonstrated  by  numerous  examples  and  by  the  testi- 
mony of  competent  physicians;  and  this  testimony  is  so  strong 
that  it  leaves  the  arguments  addressed  to  appetite  rather  than  reason 
and  conscience  without  a  foundation. 

The  same  position  is  taken  by  the  following  competent  medical 
authorities:  Dr.  Max  Gruber,  Die  Prostitution,  pp.  41,  42,  and 
Hygiene  des  Geschlechtslebens;  Hegar,  Der  Geschlechtstrieb ;  Dr. 
W.  S.  Hall,  Reproduction;  Dr.  W.  T.  Belfield,  The  Sexual  Neces- 
sity; Robert  N.  Wilson,  The  Social  Evil  in  University  Life.  Dr. 
G.  F.  Lydston  (The  Diseases  of  Society,  p.  331)  has  a  terrible 
arraignment  of  this  notion  of  "sexual  necessity"  in  his  parable  the 
"Lie  of  the  Wild  Oats,"  and  he  concludes :  "Are  not  the  wild  oats 
of  yesterday  watered  with  the  tears  of  today?  ....  Wherever 
immorality,  vice,  disease,  crime,  drunkenness,  and  insanity  most 
thrive,  there,  if  we  dig  down  to  the  very  roots  of  these  evils,  we 
find  wild  oats  the  thickest."    Here  speaks  a  man  who  recites  facts 

22  The  seminal  emissions  which  occur  at  intervals  of  from  a  few  days  to  a  few 
weeks,  usually  during  sleep,  in  healthy  continent  men,  are  entirely  normal  and 
physiologic,  and  not  evidence  of  "failing  manhood"  or  "loss  of  virility,"  as  is 
blatantly  and  falsely  stated  by  the  advertising  quack. — Dr.  J.  M.  Dodson. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  41 

from  his  consulting-room ;  he  knows ;  no  wonder  he  is  sometimes 
cynical  in  tone. 

II.    ECONOMIC  LOSS  AND  WASTE  FROM  SEXUAL  EXCESS  AND  DISEASE 

It  is  impossible  to  secure  statistical  measurements  of  the  extent 
and  material  consequences  of  the  social  evil  in  all  its  forms ;  but 
the  facts  already  exhibited  carry  with  them  direct  proof  that  eco- 
nomic loss  or  ruin  follows  in  its  wake. 

The  wage-earning  power  of  working  people  depends  on  their 
industrial  efficiency,  and  this  efficiency  is  impaired  by  any  habits  or 
diseases  which  lower  vitality,  shorten  life,  or  hinder  the  normal 
growth  of  a  healthy  population.  Many  of  the  feeble-minded, 
insane,  blind,  and  deaf  which  have  become  a  heavy  burden  upon  the 
finances  of  modern  states  have  fallen  into  a  state  of  dependence 
through  inheritance  of  the  effects  of  vicious  indulgence  and  ven- 
ereal disease  in  their  parents  and  more  remote  ancestors. 

The  cost  of  medical  treatment  by  physicians,  hospitals,  and 
unscrupulous  "specialists"  must  be  enormous.  To  our  national 
shame  be  it  said,  much  of  this  expenditure  goes  to  paid  advertise- 
ments of  the  lowest  type  of  doctors  in  newspapers  which  are  taken 
into  respectable  families  and  supported  by  the  advertisements  of 
great  merchants. 

Some  idea  of  the  economic  loss  from  venereal  diseases  may  be 
gained  by  using  such  statistics  as  we  have.  In  the  Prussian- 
German  army  during  the  years  1873-93  the  average  annual  sick- 
ness from  these  causes  was  33.2  per  cent,  of  the  active  soldiery;  in 
the  French  army  of  1883-93,  43.6  per  cent,  to  58.9  per  cent. ;  in  the 
army  of  Austria-Hungary  in  the  period  1869-93,  53-°  Per  cent,  to 
81.4  per  cent.;  in  the  Italian  army  1883-93,  79  per  cent,  to  104  per 
cent.  In  the  German  navy  there  were  sick  in  the  years  1875-76  to 
1888-89,  on  the  average,  127.9  Per  cent-  ^n  tne  English  army  it 
was  worse,  and  in  the  Dutch  army,  the  ratios  rising  to  224.5  anc^ 
294.1  per  cent.  If  we  take  all  the  European  armies  together  we 
may  say  that  each  day  seventy  to  eighty  thousand  soldiers  are 
treated  for  venereal  diseases  and  more  or  less  unfitted  for  duty. 
What  a  loss  to  the  power  of  an  army  or  navy  this  implies !  In  the 
civil  population  it  is  bad  enough.  Only  a  part  of  those  affected 
enter  hospitals,  yet  the  figures  for  these  are  startling  enough.     In 


42  THE  EIGHTH  YEARBOOK 

Prussian  hospitals  in  1877-99  about  240,000  persons,  or  58  per 
cent,  of  all  patients  were  treated  for  venereal  disorders.  In  more 
northern  lands,  because  greater  care  is  taken,  a  larger  ratio  obtains : 
in  Norway  in  1859-70  annually  0.86  per  cent  of  the  entire  popu- 
lation, in  Sweden  1.24  per  cent.,  in  Denmark  2.03  per  cent.,  in  Fin- 
land 2.27  per  cent.  An  official  inquiry  in  Prussia,  answered  by 
only  63  per  cent,  of  the  physicians,  showed  that  on  one  day,  April 
30,  1900,  about  41,000  persons  were  treated.  It  is  thought  that 
in  all  Germany  100,000  were  under  care  of  physicians  that  day. 
Kirchner  estimated  the  economic  loss  to  Prussia  alone  from  this 
cause  at  90,000,000  marks  annually. 

In  the  great  cities  the  situation  is  worse.  In  Christiana  the  aver- 
age sick  in  1859-70  were  7.66  per  cent,  of  population ;  in  Stock- 
holm, 16.04  Per  cent;  in  Copenhagen,  25.5  per  cent.  In  Russia 
where  these  maladies  are  rife,  it  is  estimated  that  13  to  2^  per 
cent  of  the  population  is  infected  and  in  some  provinces  almost  all 
are  syphilitic. 

In  Berlin  the  number  of  new  cases  of  syphilis  is  estimated  to  be 
5,000  each  year,  in  Paris  8,000  to  10,000.  On  April  30,  1900,  the 
cases  of  venereal  patients  reported  by  physicians  were  10  per  cent. 
of  the  entire  population  of  Berlin.  In  Copenhagen,  where  the 
records  are  unusually  complete,  the  number  of  new  cases  of  gonor- 
rhea reported  annually  is  56,000,  or  about  one-half  the  population. 

Of  8,500,000  persons  insured  in  the  sickness  funds  of  Germany 
6  per  cent.,  or  more  than  500,000  are  annually  afflicted  with  venereal 
diseases.  In  Berlin  3.6  per  cent,  of  the  soldiers,  8  per  cent,  of 
workmen,  13.5  per  cent,  of  female  waiters,  16.4  per  cent,  of  young 
salesmen,  and  25  per  cent,  of  students  in  the  sickness  insurance 
associations  were  treated  for  venereal  diseases.23 

The  frequency  of  venereal  diseases  varies  with  nations,  with 
districts,  and  especially,  with  density  of  population.  For  example, 
in  Germany,  these  diseases  are  more  frequent  in  northern  than  in 
southern  districts ;  more  prevalent  in  the  northeast  than  in  the  west, 
in  cities,  than  in  rural  regions.  Of  the  male  population  of  Prussia 
on  April  30,  1900,  28  in  1,000  were  infected;  in  Berlin  142  in 
1,000;  in  cities  with  over   100,000  inhabitants,    100   in   1,000;   in 

23  From  Dr.  Max  Gruber,  op.  cit. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  43 

cities  of  over  30,000  inhabitants,  45  in  1,000;  in  the  army,  15  in 
1,000.  The  frequency  of  these  maladies  varies  also  with  the 
social  classes.  Thus  in  Berlin,  of  soldiers  in  the  garrison,  4  to 
5  per  cent,  are  annually  affected;  of  wage  earners  in  the  central 
sickness  insurance  association,  8  per  cent. ;  of  female  waiters  regis- 
tered in  the  local  sickness  insurance  association  13.5  per  cent. ;  but 
the  police  records  show  30  per  cent,  of  same  class;  salesmen  16.5 
per  cent. ;  students  in  the  sickness  insurance  association  25  per  cent. 
The  figures  for  students  reveal  a  very  discouraging  condition. 

Of  12,000,000  persons  in  the  German  workingmen's  insurance 
associations  about  6  per  cent.,  or  750,000  persons  require  medical 
treatment  and  hospital  care  at  an  annual  cost  of  at  least  six  to  seven 
million  marks  (about  $1,500,000  to  $1,750,000).  To  this  loss  must 
be  added  the  loss  of  wages  and  productive  labor  caused  by  sick- 
ness, weakness,  and  the  physical  consequences  of  the  attacks.24 

Economic  loss  implies  diminution  of  the  opportunities  of  cul- 
ture ;  and  so  venereal  excesses  and  diseases  both  directly  and  indi- 
rectly affect  adversely  the  educational  process. 

No  less  than  344  persons  were  admitted,  on  an  average,  for  each  of  the 
four  years,  to  the  asylums  in  England  and  Ireland,  the  predisposing  or 
exciting  cause  of  their  insanity  being  venereal  disease. 

It  is  impossible  to  supply  accurate  statistics  relating  to  venereal  diseases 
in  the  United  Kingdom,  as  there  is  an  immense  organized  hypocrisy  and 
a  well-understood  conspiracy  of  silence  regarding  the  subject.  If  the 
committees  of  our  voluntary  hospitals  ceased  misleading  the  public,  and 
would  publish  the  actual  causes  of  the  diseases  which  the  patients  suffer 
from,  full  particulars  could  be  obtained ;  but  it  is  stated  that  if  they  did 
so,  the  public  would  withdraw  their  subscriptions.  It  is  unfortunate  that 
at  present  all  medical  statistics  relating  to  deaths  and  diseases  due  to  alco- 
holism and  venereal  diseases  are  a  source  of  joke,  and  are  absolutely  unre- 
liable and  wilfully  misleading.  Fournier  states  that  of  all  hospital  patients 
in  Paris  15  to  19  per  cent,  were  of  venereal  origin.  Morrow  places  the  per- 
centage at  the  New  York  hospitals  at  10  per  cent,  of  the  total;  Lane  in 
London  at  33  per  cent,  of  the  out-patients ;  while  in  continental  hospitals 
the  percentage  of  women  suffering  from  gonorrhoea  is  from  20  to  25. 
Prostitution  and  venereal  diseases  are  interchangeable  terms,  for  there  is 
always  venereal  disease  where  there  is  prostitution. 

A  reference  to  the  annual  reports  of  the  surgeons-general  of  the  British 
M  Dr.  A.  Blaschko,  Die  Geschlechts-Krankheiten,  Berlin,  1907. 


44  THE  EIGHTH  YEARBOOK 

army  and  navy  give  us  some  idea  of  the  terrible  amount  of  venereal  diseases 
there  present.  During  the  year  1901,  of  100,811  troops  (army)  stationed  in 
the  United  Kingdom,  there  were  1,936  admissions  for  primary  syphilis;  988, 
for  soft  chancre;  1,907,  for  secondary  syphilis;  5,794  for  gonorrhoea.  That 
is,  10,625  "admissions"  in  twelve  months.  Of  the  British  army  in  India 
and  of  60,838  troops,  there  were  admitted  to  hospital  2,021  for  primary 
syphilis;  3,921,  for  soft  chancre;  3,544,  for  secondary  syphilis;  7,303,  for 
gonorrhoea.  That  is,  16,789  admissions  in  twelve  months.  Of  European 
troops  stationed  in  other  parts  of  the  Empire  (fifteen  stations)  there  were 
admitted  to  hospital  655  for  primary  syphilis;  1,488  for  soft  chancre; 
842  for  secondary  syphilis;  3,258  for  gonorrhoea.  In  the  Royal  Navy, 
with  98,410  afloat,  there  were  3,293  persons  treated  for  primary  syphilis; 
2,110  for  secondary  syphilis,  5,790  for  gonorrhoea.     That  is  11,193  persons. 

It  is  calculated  that  the  army  lost  514,855  days'  active  duty  owing  to 
venereal  diseases  among  the  troops,  the  sick  rate  being  about  1 12.2  per 
1,000  men  in  one  year. 

Supposing  these  sailors  and  soldiers  had  been  suffering  from  plague, 
cholera,  or  smallpox,  the  daily  papers  would  have  spread  such  facts  broad- 
cast, and  questions  would  have  been  asked  in  Parliament.  But  such  ques- 
tions are  not  asked  about  venereal  diseases,  chiefly  because  we  are  cowards; 
we  do  not  wish  to  save  thousands  of  children  from  death  and  disease,  and 
are  afraid  of  Mrs.  Grundy.  We  know  that  very  few  of  these  men  are 
really  cured,  and  that  they  come  home,  go  ashore,  and  wander  about 
spreading  the  disease  broadcast,  and,  by  giving  it  to  nursemaids  and  others, 
are  the  means  of  carrying  venereal  disease  to  children  in  private  families. 
The  Registrar-General,  in  his  Sixty-sixth  Annual  Report,  states  that  in 
one  year,  in  England  and  Wales,  986  males  and  843  females  died  from 
syphilis,  and  12  males  and  13  females  from  gonorrhoea,  a  total  of  2,755. 
These  statistics  are  much  below  the  mark.  What  of  the  19,081  children 
who  died  because  they  were  born  before  full  time?  These  figures  refer 
only  to  those  who  die ;  but  what  of  the  immense  total  who  are  alive  but 
suffering  from  the  effects  of  venereal  disease?  It  is  interesting  to  note  the 
amount  of  venereal  diseases  which  came  to  light,  for  the  year  1902,  in  the 
French  army.  There  were  485,207  officers,  non-commissioned  officers,  and 
men  in  the  home  service,  and  77,185  in  the  foreign.  The  following  are 
the  statistics:  Home  Service:  syphilis,  3,024,  or  6.2  per  1,000;  soft  chancre, 
1,071,  or  2.2  per  1,000;  gonorrhoea,  8,722,  or  17.9  per  1,000,  a  total  of  26.3 
per  1,000.  Foreign  Service:  syphilis,  1,219,  or  15.8  per  1,000;  soft  chancre, 
1,209,  or  15.7  per  1,000;  gonorrhoea,  2,986,  or  38.7  per  1,000,  a  total  of  70.2 
per  1,000. 

If  reference  be  made  to  the  Fifty-ninth  Report  of  the  Commissioners 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  45 

in  Lunacy  (1905),  Table  XXII  shows  the  influence  of  venereal  diseases  in 
causing  insanity.  In  the  yearly  average  for  five  years  the  condition  of 
unsound  mind  in  489  persons  was  due  to  venereal  diseases.  Again  Table 
XIV  refers  to  deaths  of  lunatics  from  general  paralysis  of  the'  insane 
(G.  P.  I.)  1  and  points  out  that  of  a  total  of  9,288  deaths  in  asylums,  no 
less  than  1,665  deaths  were  due  to  general  paralysis  of  the  insane.  It  is  now 
held  that  the  chief  cause  of  general  paralysis  of  the  insane  is  syphilis. 
Mott,  I  think,  states  that  from  25  to  40  per  cent,  of  insanity  is  due  to 
syphilis. 

As  bearing  upon  the  devastating  action  of  venereal  disease  upon  chil- 
dren, Fournier  says:  "Syphilis  is  the  essential  murderer  of  those  young 
in  years;  it  is  the  veritable  tomb  of  infants;  it  is  the  cause  of  death  before 
birth,  at  the  moment  of  birth,  after  birth,  within  the  first  week  of  birth, 
or  it  may  await  the  first  year.  Syphilis,  alcoholism,  and  tuberculosis  con- 
stitute the  triad  of  contemporaries."  He  gives  the  following  facts :  Of 
28  mothers  who  had  syphilis  1  child  survived  and  27  died.  LeFileur's 
statistics  show  that  of  414  syphilitic  wives — who  were  pregnant  when 
suffering  from  syphilis — who  had  among  them  260  children,  no  less  than 
141  of  these  died  within  one  month  after  birth.  Of  the  414  pregnancies 
295  infants  died,  or  about  three  deaths  in  every  four  births.  When  both 
parents  are  infected  with  syphilis  the  infant  mortality  is  68  per  cent,  in 
hospital  practice,  and  60  per  cent,  in  private  practice.  Fournier  terms  the 
first  year  of  the  infant's  life  'Tannee  terrible,"  when  speaking  of  the 
devastating  influences  of  syphilis. 

This  is  a  fearful  death-rate,  much  higher  than  that  following  small- 
pox, scarlet  fever,  or  typhoid,  and  shows  that  the  human  animal  is  some- 
what of  a  glut  in  the  market.  If  other  diseases  of  infancy,  and  especially 
gonorrhoeal  ophthalmia  in  infants — a  disease  which  sends  many  to  insti- 
tutions for  the  blind,  makes  many  more  become  a  charge  to  the  Poor  Law, 
and  prevents  others  from  earning  a  livelihood — were  considered  faithfully, 
the  widespreading  results  of  venereal  disease  would  be  more  carefully 
studied.  In  New  York  in  one  year,  of  1,941  mothers  with  gonorrhoea,  265 
of  their  babies  suffered  from  gonorrhoeal  ophthalmia.  In  Switerland  one 
in  every  five  cases  of  blindness  is  due  to  gonorrhoea.  In  New  York  of 
the  1,941  cases  of  maternal  gonorrhoea,  218  female  children  suffered  from 
vulvo-vaginitis. 

In  all  the  discussions  bearing  upon  the  falling  birth-rate,  I  have  seen 
no  notice  given  to  venereal  diseases  and  operations  upon  the  uterine  organs 
as  causes  of  this  fall.     I  contend  that  they  are  very  serious  causes. 

How  can  venereal  disease  be  stamped  out? — No  practical  person  holds 
that  the  registration  of  prostitutes  on  the  Continent,  or  in  England  when 


46  THE  EIGHTH   YEARBOOK 

the  Contagious  Diseases  Acts  were  in  force,  has  been,  or  can  be,  of  any 
service. 

I  would,  however,  suggest  that  notification  of  venereal  diseases  to 
the  health  authority,  or  to  some  central  body  in  London,  Edinburgh,  and 
Dublin,  be  adopted,  and  that  hospitals,  supported  by  the  municipalities,  be 
established  at  which  all  poor  venereals  can  obtain  free  treatment. 

Bearing  upon  the  above  suggestions,  I  would  point  out  that  we  now 
have  compulsory  notification  of  infectious  diseases.  Why  not  have  notifi- 
cation of  contagious  diseases — especially  as  contagious  diseases  cause  more 
widespread  evils?20 

Dr.  Fournier,  one  of  the  highest  French  authorities  says: 

Syphilis  causes  certain  forms  of  insanity.  Of  4,700  patients,  2,009,  or 
42.7  per  cent,  had  nervous  disorders.  All  the  body  is  affected;  general 
paralysis,  locomotor  ataxia,  cancer  of  the  tongue. 

Collective  damage:  (1)  Wives  are  infected.  Twenty  per  cent,  of 
women  who  have  syphilis  take  it  from  their  husbands;  (2)  Venereal 
diseases  given  by  husbands  drive  women  to  divorce ;  the  family  is  ruined ; 
a  great  source  of  neglected  and  delinquent  children,  so  costly  and  danger- 
ous to  the  state. 

Heredity :  Syphilis  slays  infants  by  hecatombs ;  60  per  cent,  in  the 
city  at  large,  84.86  per  cent,  in  hospitals,  of  infants  of  syphilitic  mothers 
die.     Idiocy,  insanity,  abortion,  still-births  result.28 

If  it  is  said  that  the  foregoing  statistics  apply  only  to  European 
countries,  and  that  in  the  United  States  the  situation  is  not  so 
alarming,  we  must  reply  by  adducing  the  results  of  investigations 
by  American  physicians.  In  a  communication  from  Dr.  Prince  A. 
Morrow  the  economic  consequences  of  venereal  diseases  are  dis- 
cussed : 

While  the  enormous  prevalence  of  venereal  infection  is  undeniable, 
and  its  dangers,  both  individual  and  social,  are  scientifically  demonstrated, 
yet  any  estimate  of  the  money  loss  to  the  community  or  nation  must  be 
purely  conjectural  and  lacking  in  scientific  accuracy.  Such  an  estimate 
must  include  as  items:  (1)  invalidism,  often  permanent;  (2)  loss  of  wage- 
earning  capacity;  (3)  the  cost  of  treatment,  incalculable  but  enormous; 
(4)    the  cost  of   educating  and  caring  for  blind  children,  the   idiots,   deaf 

25  Robert  R.  Rentoul,  Race  Culture,  chap.    xvii. 

28  M.  F.  Hennequin,  Rapport  general  sur  les  travaux  de  la  Commission 
Extra-parlementaire  du  Regime  des  Mams.     Melun,  1908;  2  vols. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  47 

mutes,  the  insane,  and  other  defectives ;  (5)  the  loss  of  citizens  to  the  state 

from    the    sterilizing    influence    of    gonorrhea In    the    report    of    the 

surgeon-general  of  the  U.  S.  army  for  1904,  it  is  stated  that  of  every  1,000 
soldiers  stationed  in  the  United  States,  167  were  admitted  to  the  hospital 
for  gonorrhea  or  syphilis.  This  was  more  than  double  the  morbidity  of 
tonsilitis,  the  next  most  common  of  the  diseases  to  which  the  troop  men  were 
subject In  the  troops  stationed  in  the  Philippines,  the  venereal  mor- 
bidity was  297  per  1,000,  largely  exceeding  the  morbidity  from  malarial 
fevers  and  diarrhea;  22  out  of  every  1,000  soldiers  were  constantly  in- 
effective  from   venereal   diseases — four  times   as   many  as    from   any   other 

disease 

The  statistics  of  the  Navy  Department  show  during  the  same  year 
that  venereal  disease  was  chargeable  with  a  percentage  of  25.2  per  cent,  of 
the  total  number  of  sick  days  in  the  hospital  from  all  causes  combined.  In 
four  years  949  men  were  discharged  from  the  navy  for  disability  from 
venereal  diseases. 

The  most  extended  investigation  ever  made  in  this  country  was 
that  of  the  "Committee  of  Seven  on  the  Prophylaxis  of  Venereal 
Disease  in  New  York  City"  in  1901.  The  committee  was  composed 
of  medical  men  of  recognized  standing.  A  circular  letter  of  ques- 
tions was  sent  to  4,750  physicians  resident  in  Greater  New  York, 
of  whom  886  replied,  but  only  678  furnished  statistics.  These 
reported  23,196  cases  (15,969  gonorrhea  and  7,200  syphilis).  From 
this  the  committee  estimated  that  about  162,372  cases  were  treated 
in  that  year  in  the  city.  To  these  must  be  added  the  large  number 
treated  by  druggists  and  quacks.  The  records  of  hospitals  and  dis- 
pensaries furnished  further  cases  in  great  number.  In  public  and 
private  practice  they  thought  225,000  cases  were  treated.  If  we 
compare  the  morbidity  of  venereal  diseases  with  that  of  other  infec- 
tious diseases  we  find  a  startling  contrast;  for  in  1900  the  records 
showed  that  of  measles  there  were  only  12,530  cases;  diphtheria, 
11,001  cases;  scarlet  fever,  7,387  cases;  chicken-pox,  1,251  cases; 
smallpox,  99  cases ;  tuberculosis,  8,877  cases.  Tuberculosis  is  not 
adequately  reported ;  the  others  are  approximately  correct ;  and 
against  these  we  have  a  venereal  morbidity  of  225,000  cases.  Yet, 
officially,  venereal  diseases  do  not  exist  in  New  York  City,  says 
the  report.  There  is  a  conspiracy  of  hypocrisy  to  conceal  the  pres- 
ence of  these  plagues  and  pretend  that  they  do  not  exist. 


48  THE  EIGHTH  YEARBOOK 

Another  valuable  investigation  was  made  by  the  "Committee  on 
Sanitary  and  Moral  Prophylaxis"  in  Baltimore: 

A  circular  letter  was  drafted,  asking  for  detailed  reports  of  venereal 
cases,  and  a  copy  was  sent  to  each  of  the  1,200  physicians  resident  in 
Baltimore.  Permission  to  inspect  their  records  was  also  asked  from  the 
superintendents  of  the  various  dispensaries  and  public  institutions  in  Balti- 
more, in  which  this  class  of  cases  is  received.  To  the  circular  letters  sent 
to  the  members  of  the  medical  profession  relating  to  the  statistics  of  pri- 
vate practice,  224  replies  were  received,  about  18  per  cent. 

The  statistics  obtained  from  physicians  in  private  practice  consist  entirely 
of  the  reports  handed  in  by  the  151  physicians  whose  returns  were  appar- 
ently careful  and  accurate.  The  total  number  of  cases  reported  by  them 
for  the  year  1906  is  3,090 — 2,195  cases  of  gonorrhoea  and  895  cases  of 
syphilis.  These  reports  have  been  tabulated  and  preserved  in  a  permanent 
form  for  reference.  It  is  to  be  understood  that  no  cases  of  chancroid  are 
included  in  these  figures.  While  the  frequency  of  chancroid  is  variable, 
being  less  in  private  than  in  public  practice,  the  statistics  of  all  authors  in 
all  countries  estimate  it  at  from  9  to  35  per  cent,  of  the  total  venereal 
morbidity. 

Taking  this  aggregate  of  3,090  cases  and  knowing  that  the  151  phy- 
sicians who  reported  them  represent  only  one-eighth  of  the  total  number 
of  practicing  physicians  in  Baltimore,  it  becomes  evident  that  the  num- 
ber of  cases  here  reported  represents  only  a  small  fraction  of  the  total  number 
of  cases  actually  treated  in  private  practice  during  the  year  of  1906.  More- 
over, when  account  is  taken  of  the  quack  doctors  and  advertising  "special- 
ists" who  treat  venereal  patients  it  is  obvious  that  the  number  of  venereal 
cases  here  recorded  must  fall  far  short  of  the  actual  number  of  cases 
treated.  It  is  only  necessary  to  glance  at  the  advertisements  in  the  daily 
papers  or  to  visit  the  expensive  offices  of  the  advertising  quacks  to  reap 
assurance  of  the  fact  that  venereal  patients  bring  in  large  returns  to  the 
irregular  practitioner.  The  amount  of  literature  which  the  charlatans  cir- 
culate is  itself  conclusive  evidence  of  the  thriving  practice  that  they  drive. 
On  account  of  the  shame  and  secrecy  associated  with  the  social  diseases, 
the  venereal  patient  is  particularly  prone  to  be  duped  by  the  fakir. 

It  is  well  known  that  many  drug  stores  in  this  city  owe  a  large  part 
of  their  revenue  to  this  class  of  practice  and  the  many  "sure  cures"  and 
blood  purifiers  which  may  be  found  upon  their  shelves  bear  witness  to  this 
fact.  In  addition  to  the  patients  who  are  treated  by  the  irregular  prac- 
titioner, are  those  who  remain  untreated  or  who  use  prescriptions  given 
them  by  friends,  and  although  it  is  impossible  to  estimate  the  number  of 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  49 

these  cases  any  fairminded  physician  must  admit  that  the  number  is  large. 
The  testimony  of  European  physicians  is  that  from  25  to  50  per  cent,  of 
all  venereals  are  treated  by  charlatans. 

On  further  analysis  of  those  statistics  it  was  found  that  1,328  cases 
of  gonorrhoea  occurred  in  men,  542  cases  in  women,  and  114  cases  in 
children.  Of  the  infections  in  women  202  were  particularly  noted  as 
marital  infections.  The  proportion  of  women  and  children  to  men  in  the 
statistics  regarding  syphilis  is  remarkably  high.  In  men  489  cases  occurred, 
303  in  women,  and  103  in  children.  Of  the  cases  occurring  in  children  93 
were  classified  as  hereditary  infections.  Notes  as  to  the  source  of  the 
infection  were,  public  prostitutes  678,  clandestine  prostitutes  625,  extra- 
genital infection  184,  and  "source  unknown"  3y6. 

In  examining  the  dispensary  and  hospital  records,  the  Committee 
recorded  only  those  cases  where  a  definite  diagnosis  of  gonorrhoea  or 
syphilis  was  made.  In  some  of  the  hospitals  and  dispensaries  it  was 
impossible  to  obtain  any  reliable  statistics  owing  to  the  insufficiencies  in 
the  histories.  In  many  of  the  cases  no  diagnosis  was  put  down,  and  in 
some  dispensaries  no  available  histories  were  to  be  had.  In  one  promi- 
nent dispensary,  for  example,  7,593  patients  were  listed  for  the  year  1906, 
but  the  histories  were  so  incomplete  that  it  was  impossible  to  obtain  any 
reliable  information  from  them.  Only  17  of  the  41  hospitals  in  Baltimore 
afforded  any  opportunities  for  statistical  research,  so  the  figures  which 
follow  represent  only  the  cases  treated  in  those  17  institutions  during  the 
year  1906.  The  total  number  of  cases  recorded  was  6,360.  Of  these  4,553 
were  diagnosed  as  gonorrhoea  and  1,807  as  syphilis.  Owing  to  the  lack  of 
available  information  in  over  one-half  of  our  hospitals  and  dispensaries 
these  figures  represent  most  inadequately  the  number  of  venereal  patients 
actually  treated  in  our  public  institutions  in  the  year  1906.  Despite  the 
fact,  however,  the  extent  of  venereal  morbidity  embodied  in  this  report  far 
exceeds  the  morbidity  resulting  from  the  other  contagious  diseases  in 
the  year  1906,  as  officially  recorded  by  the  Board  of  Health. 

In  the  year  1906,  575  cases  of  measles  were  reported;  1,172  cases  of 
diphtheria;  577  cases  of  scarlet  fever;  175  cases  of  chicken-pox;  58  cases 
of  smallpox;  1,215  cases  of  typhoid  fever;  465  cases  of  whooping  cough; 
57  cases  of  mumps,  and  733  cases  of  tuberculosis,  making  a  grand  total  of 
5,047.  The  number  of  cases  of  tuberculosis  reported  is  of  course  absurdly 
small,  but  since  the  tuberculosis  campaign  began  the  number  of  notifications 
has  been  considerably  increased.  This  illustrates  again  the  signal  advantage 
of  educating  the  general  public  in  any  effort  to  make  preventive  medicine 
efficacious. 

Taking  now  the  number  of  cases  of  contagious  disease  reported  at  the 


50  THE  EIGHTH   YEARBOOK 

Health  Bureau,  let  us  compare  with  it  the  number  of  cases  of  venereal 
disease  reported  by  the  committee.  There  were  reported  3,090  cases  in 
private  practice  and  6,360  cases  were  recorded  in  the  hospitals  and  dis- 
pensaries investigated,  making  a  grand  total  of  9,450  cases  of  venereal 
disease.  Opposed  to  this  morbidity  we  have  the  sum  total  of  5,047  cases 
representing  the  collective  morbidity  resulting  from  the  other  contagious 
diseases  in  the  year  1906. 

When  we  notice  that  only  58  cases  of  smallpox  were  reported  in  1906 
and  then  realize  that  even  the  wholly  inadequate  figures  of  the  committee 
show  2,706  cases  of  great  pox  in  the  same  year,  the  thought  must  occur  to 
us  that  the  medical  profession  might  for  a  time  at  least  advantageously 
turn  its  attention  to  the  greater  evil.27 

No  doubt  similar  results  would  be  found  in  other  cities.  We 
may  add  fragmentary  illustrations  which  indicate  that  New  York 
and  Baltimore  are  by  no  means  exceptional. 

So  prevalent  are  these  [venereal  diseases]  in  our  large  cities  that  at 
least  half  the  adult  male  population  of  all  social  grades,  according  to  con- 
servative estimates,  contract  one  or  both  of  them.28 

It  is  well  known  that  insanity  is  one  of  the  heaviest  burdens  on 
the  financial  resources  of  our  states.  The  cause  of  insanity,  even 
when  known  to  be  venereal  disease,  is  often  covered  up  under  some 
other  name.     Yet  we  discover  some  facts  in  reports  of  asylums. 

In  the  Ninth  Annual  Report  of  the  State  Board  of  Insanity  of 
Massachusetts  for  the  year  ending  November  30,  1907,  p.  15,  we 
find  the  following: 

First  cases  received  2,414.  One  insane  person  came  under  care  for  the 
first  time  from  every   1,291   of  the  estimated  population  of  the  state.     No 

causes   of   insanity  were   assigned  by  the  physicians  of   the   hospital 

Congenital  causes  were  assigned  in  5.47  per  cent. ;  heredity  alone  in  5.26  per 

cent.,  with  other  causes  14.13  per  cent Alcoholic  intemperance  alone 

in  16.65  per  cent.,  with  other  causes  5.35  per  cent.,  making  alcohol  a  causa- 
tive factor  in  22  per  cent.,  senility  in  13.79  per  cent. ;  coarse  brain  lesions 
in  5.30  per  cent.;  syphilis  in  3.19  per  cent.  In  the  insane  ward  of  the  State 
Hospital  the  average  rate  for  three  years  (1905-7)  was  5.93  per  cent.;  in 
Worcester  Hospital  the  highest.  6.13  per  cent. 

27  Reported  by  D.  R.  Hooker,  M.D.,  Maryland  Medical  Journal,  February, 
1908. 

28  W.  T.  Belfield,  Man  and  Woman,  p.  86. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  51 

The  economic  loss  due  to  venereal  diseases  is  indicated  in  this 
citation  from  a  circular  of  the  Chicago  Society  of  Social  Hygiene : 

Gonorrhoea,  while  usually  cured  without  apparent  loss  of  health,  has 
always  serious  possibilities :  it  kills  about  one  in  two  hundred ;  it  perma- 
nently maims  one  in  a  hundred ;  it  impairs  the  sexual  power  and  fertility 
of  a  much  larger  number ;  it  often  produces  urethral  stricture,  which  later 
may  cause  loss  of  health  and  even  of  life ;  and  in  many  cases  it  causes 
chronic  pain  and  distress  in  the  sexual  organs  with  severe  mental  depres- 
sion. The  loss  of  health,  time,  and  money  entailed  by  these  sequels  and 
their  treatment  may  far  exceed  that  occasioned  by  the  original  disease. 

The  disaster  to  the  individual  wrought  by  syphilis  is  shown  in  the  atti- 
tude of  the  leading  insurance  companies  toward  those  so  infected — a  purely 
business  proposition  devoid  of  all  sentimental  considerations.  They  refuse 
to  insure  the  life  of  a  syphilitic  person  for  four  or  five  years  after  the 
disease  was  contracted,  and  then  only  upon  special  terms.  For  their 
records  prove  that  syphilis  shortens  life.29 

One  of  the  highest  authorities  on  pauperism,  Amos  G.  Warner 
{American  Charities,  pp.  66-71,  ed.  of  1894),  has  given  us  the 
result  of  a  prolonged  expert  study  of  degenerate  persons  in  Ameri- 
can cities: 

Careful  observers  believe  it   [licentiousness]   to  be  a  more  constant  and 

fundamental  cause  of  degeneration  than  intemperance No  boy  among 

boys,  or  man  among  men,  can  have  failed  to  have  evidence  thrust  upon 
him  showing  that  a  very  great  amount  of  vitality  is  burnt  out  by  the  fires 

of  lust Personal  acquaintance  with  railroad  day  laborers,  and  others 

of  a  similar  class,  convinces  the  writer  that  they  are  commonly  kept  from 
rising  in  the  industrial  scale  by  their  sensuality,  and  that  it  is  this  and  the 
resulting  degeneration  that  finally  converts  them  into  lazy  vagabonds.  The 
inherent  uncleanness  of  their  minds  prevents  them  from  rising  above  the 
rank  of  day  laborers,  and  finally  incapacitates  them  even  for  that  position. 
It  may  also  be  suggested  that  the  modern  man  has  a  stronger  imagination 
than  the  man  of  a  few  hundred  years  ago,  and  that  sensuality  destroys  him 
the  more  rapidly. 

To  this  testimony  might  be  added  that  of  Dugdale  in  his  re- 
markable story  of  the  Jukes,  and  McCulloch's  story  of  the  Ishmaels. 
Venereal  diseases  are  spread  even  to  innocent  persons  by  the  float- 
ing class  of  irresponsible  vagrants.30 

■  Cf.  W.  T.  Belfield,  Man  and  Woman,  p.  90. 

30  See  Report  of  the  Departmental  Committee  on  Vagrancy  (British),  Vol. 
II,  pp.  105,  203. 


52  THE  EIGHTH  YEARBOOK 

III.    MORAL    LOSS    CAUSED   BY   THE   SOCIAL    EVIL   AND   SEXUAL   VICES 

This  subject  does  not  lend  itself  to  precise  statistical  treatment, 
yet  the  argument  does  not  lack  cogency.  In  the  extreme  form  we 
discern  the  spiritual  ruin  wrought  by  wicked  indulgence,  in  the 
wrecks  of  humanity  inclosed  in  prisons  and  cared  for  in  asylums  and 
hospitals. 

A  curious  and  somber  aspect  of  this  matter  is  that  men  who 
indulge  in  base  vice  lose  the  fine  quality  of  conscience  without 
knowing  it.  First  goes  the  power  to  blush;  then  comes  the  levity, 
the  coarseness,  the  positive  delight  in  obscenity  which  shocks  the 
right  minded.  The  roue  loses  faith  in  the  purity  of  women  and  of 
men,  and  judges  the  world  by  himself.  It  is  simply  inconceivable 
to  him  that  anyone  can  be  other  than  the  debased  and  polluted 
creature  which  he  has  voluntarily  made  himself.31 

31  A.  Marro,  La  puberte,  pp.  517  ff. ;  G.  F.  Lydston,  The  Diseases  of  Society. 


CHAPTER  II 

METHODS   OF   SOCIAL  CONTROL  AND   MOVEMENTS   FOR 
AMELIORATION 

It  is  true  that  this  Handbook  is  primarily  for  teachers  and  that 
its  chief  object  is  to  discuss  the  best  educational  methods  of  dealing 
with  the  problems  connected  with  the  sexual  life.  But  a  considera- 
tion of  various  policies  of  regulation  and  control  is  necessary  at 
this  point  for  at  least  three  good  reasons;  first,  because  many 
teachers  are  among  the  leaders  of  thought  in  their  communities, 
and  their  attitude  is  a  large  factor  in  shaping  a  sound  public 
opinion;  second,  because  a  critical  examination  of  all  proposed 
methods  of  police  regulation  must  reveal  their  partial  failure  and 
show  the  necessity  for  an  educational  campaign ;  third,  because 
many  of  the  arguments  used  for  certain  methods  of  regulation  tend 
to  poison  the  moral  nature  and  undo  the  work  of  faithful  teachers. 

No  scheme  of  external  police  regulation  can  ever  take  the  place 
of  a  sound  moral  training  and  that  rational  self-control  which  is  the 
only  ultimate  guaranty  of  good  citizenship.  Yet  police  and  sani- 
tary control  of  some  kind  is  necessary.  While  vice  and  crime 
exist,  and  until  education  in  morality  and  religion  has  done  its  per- 
fect work,  society  must  employ  its  police  powers  as  far  as  these 
are  available  to  diminish  disease,  protect  the  innocent,  and  guard 
the  ignorant  against  temptation.  Teachers,  like  all  other  thought- 
ful and  responsible  formers  of  opinion  and  character,  should  be 
acquainted  with  the  actual  and  proposed  measures  of  governments. 

I.    THE   SANITARY  POINT  OF  VIEW,   AND   "REGLEMENTATION" 

Physicians  very  properly  regard  it  as  their  social  duty  to  guard 
in  all  possible  ways  against  the  communication  of  infectious  diseases 
of  all  kinds.  They  lead  the  civilized  world  in  advocating  and 
organizing  measures  for  diminishing  typhoid  fever,  tuberculosis, 
scarlet  fever,  and  other  communicable  maladies ;  and  for  this  they 
deserve  our  praise  and  our  support.  Now,  medical  practitioners  are 
compelled  in  their  daily  rounds  of  duty  to  come  into  contact  with 
the  loathsome  and  dangerous  diseases  already  discussed.     Naturally 

53 


54  THE  EIGHTH  YEARBOOK 

they  inquire  what  society  can  do  to  diminish  the  spread  of  these 
infectious  diseases  which,  for  the  most  part,  originate  with  prosti- 
tutes and  their  male  clients. 

Policy  of  state  (or  municipal)  license  or  toleration,  on  the  basis 
of  inspection,  control,  and  certificates  of  physicians. — This  policy 
has  many  advocates,  and  it  is  followed  in  France,  Germany  and  other 
nations.  It  is  claimed  that  it  is  the  duty  of  the  state  to  prevent  or  at 
least  to  diminish  all  diseases,  no  matter  what  their  nature,  and  so 
protect  the  public.  To  carry  out  a  system  of  effective  regulation  it 
would  be  necessary  ( I )  to  distinguish  and  separate  the  diseased  from 
the  healthy  prostitutes;  (2)  to  bring  all  harlots  into  special  quarters 
and  houses  where  they  can  be  supervised;  (3)  to  discover  and  send 
to  hospitals  every  harlot  as  soon  as  she  is  diseased  and  so  capable 
of  infecting  men;  (4)  also  to  examine  every  man  who  enters  a 
house  of  ill  fame  to  be  sure  that  he  is  not  diseased. 

Is  such  a  policy  capable  of  being  carried  out?  An  examination 
of  the  facts  shows  what  might  be  expected,  that  not  one  part  of 
this  scheme  can  be  carried  out  thoroughly.  Of  course  infection  may 
be  prevented  in  a  certain  number  of  cases;  the  liability  to  infect 
may  be  reduced  in  particular  instances ;  and  it  would  be  dishonest 
to  deny  that  something  has  been  achieved  by  systems  of  regulation 
and  toleration. 

We  cite  the  argument  of  Professor  Fournier  in  favor  of  the 
system  of  reglementation.1  Dr.  Fournier  first  gives  evidence  in 
support  of  the  assertion  that  syphilis  and  gonorrhea  are  social 
plagues,  ranking  along  with  alcoholism  and  tuberculosis  as  agents 
of  destruction.  The  evil  is  fourfold:  these  diseases  inflict  injuries 
on  the  diseased  person;  they  are  a  source  of  misery  to  the  wife  and 
children;  both  occasion  grave  hereditary  harm;  and  thus  through 
injury  to  persons  and  families  the  nation  suffers.  The  illustrations 
of  this  argument  we  have  given  elsewhere  in  this  discussion. 

Next  Dr.  Fournier  takes  up  the  objections  to  medical  super- 
vision of  prostitution,  which  is  the  source  of  these  venereal  diseases : 
that  such  medical  supervision  is  injurious,  inadequate,  and  useless. 
He  examines  the  assertion  of  the  "abolitionists"  that  it  is  injurious 

1  M.  F.  Hennequin,  Rapport  general  sur  les  travaux  de  la  Commission  Extra- 
parlementaire  du  Regime  des  Mccurs,   1908. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  55 

to  public  health  on  account  of  the  false  security  which  it  promises 
and  by  the  terror  which  it  inspires  in  prostitutes.  In  reply  he  says : 
The  state  has  never  corrupted  anyone,  nor  advised  anyone  to  resort  by 
preference  to  the  women  registered  for  medical  control;  and  the  guarantees 
offered  by  sanitary  control  are  not  very  attractive,  as  is  shown  by  the  fact 
that  the  public  houses,  which  are  most  secure,  have  long  declined  in  num- 
bers, notably  at  Paris,  where,  in  a  period  of  sixty  years  their  number  has 
fallen  from  235  to  48  in  1901. 

To  the  objection  that  reglementation  inspires  the  women  with 
fear  and  keeps  them  from  registration  and  control,  he  says : 

The  objection  is  valid,  so  far  as  Paris  is  concerned,  since  the  women 
dread  Saint-Lazare  because  it  is  rather  a  prison  than  a  hospital.  Apathy, 
indolence,  carelessness,  vague  fear  of  remedies  and  physicians,  and  often 
the  prohibition  of  their  employers  who  do  not  permit  them  to  interrupt  their 
occupation  act  as  a  deterrent  to  registration. 

Another  objection  is  that  reglementation  is  inadequate.  Dr. 
Fournier  says : 

The  complaint  is  just,  but  reglementation  has  of  necessity  a  limited 
field,  and  reaches  only  the  lower  levels.  But  even  if  it  restricts  disease  a 
little  it  should  be  used.  Private  charity  is  good,  although  it  leaves  many 
poor  without  relief;  and  the  police  force  is  useful  though  it  does  not 
detect  all  criminals. 

It  is  claimed  by  "abolitionists"  that  reglementation  is  useless. 
Dr.  Fournier  here  enters  upon  an  examination  of  the  results  of  the 
Contagious  Diseases  Acts  in  England  and  similar  legislation  in 
Italy.  This  dispute  is  too  complicated  to  repeat  here  and  leads  to 
no  conclusive  result  for  either  side. 

Dr.  Fournier  then  states  the  programme  which  he  claims  com- 
mands the  support  of  the  majority  of  medical  men.  The  object  of 
this  programme  of  action  is  to  reduce  the  physical  evils  of  prosti- 
tution (I'assainement  de  la  prostitution).  It  demands  all  that  is 
advantageous  to  public  health  and  takes  no'  thought  of  anything 
further.  It  demands  a  medical  inspection  of  prostitutes  at  fixed 
intervals,  and,  when  they  are  found  to  be  diseased,  their  incarcera- 
tion in  a  special  asylum.  The  programme  is  summed  up  in  these 
words :  medical  supervision  of  prostitution,  a  supervision  which 
shall  be  legal,  humane,  and  reformatory.  By  legal  supervision,  he 
means  the  substitution,  in  place  of  the  arbitrary,  omnipotent,  and 


56  THE  EIGHTH  YEARBOOK 

capricious  power  of  the  police,  of  a  system  in  which  the  law  pro- 
vides, defines,  and  limits  all  the  measures  which  are  to  be  used  for 
the  defense  of  public  morals  and  health,  such  as  the  arrest  of  women 
for  public  solicitation,  or  their  sequestration  when  they  have  con- 
tagious diseases.  This  supervision  must  be  humane;  that  is,  must 
be  free  from  the  persecutions  of  an  intolerant  discipline,  and  from 
all  punishment;  in  a  word,  from  all  requirements  which  simply 
exasperate  women  and  compel  them  to  shake  off  an  odious  yoke,  to 
the  great  detriment  of  the  public  health.  The  women  under  re- 
straint by  reason  of  contagious  disease  should  be  treated  as  sick 
and  not  as  criminal  persons,  with  all  the  kindness  which  is  due  any 
sick  person.  They  should  not  be  kept  in  a  prison  but  in  a  special 
asylum,  until  a  certificate  of  health  is  given.  Moral  influences 
should  be  used  during  the  stay  in  the  asylum;  a  trade  should  be 
taught  by  which  the  woman  can  earn  an  honest  living,  and  she 
should  then  be  encouraged  and  helped  to  lead  a  better  life.  Per- 
haps a  more  authoritative  and  competent  representation  of  the  sys- 
tem of  reglementation  could  not  be  furnished.  In  another  plea  for 
public  regulation  according  to  the  French  method,  Dr.  Fournier 
says: 

Do  not  accuse  us  hygienists  and  physicians  of  not  having  done  our  best 
to  safeguard  the  public  health,  for  we  have  struggled  a  long  time  to  realize 
a  better  condition,  but  our  counsel  and  our  adjurations  have  simply  been 
heard  in  high  places.  Still  public  opinion  is  energetically  urged  to  abolish 
all  medical  supervision  of  prostitution  by  a  powerful  society  called  the 
Federation  for  Abolition.  We  count  on  the  good  sense  of  the  French 
people  to  resist  such  doctrines,  the  result  of  which  would  be  to  multiply  the 
venereal  peril  tenfold.2 

This  passage  is  cited  simply  to  show  the  point  of  view  of  some 
French  physicians  and  some  in  America  also. 

On  the  other  hand,  the  arguments  of  the  abolitionists  in  France 
are  presented  by  Dr.  Angagneur  who,  in  his  reply  to  Dr.  Fournier, 
reached  the  following  conclusions : 

i.  Venereal  diseases  have  not  the  serious  importance  ascribed  to  them 
by  the  public  and  above  all  by  specialists.  Syphilis,  the  most  important  of 
all,  has  little  influence  on  general  morality  and  on  the  increase  of  population. 

2  Dr.  Alfred  Fournier,  Pour  nos  fils,  p.  46. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  57 

2.  The  variations  in  the  rate  of  venereal  morbidity  are  about  the  same 
throughout  Europe.  Venereal  disease  is  decreasing  in  all  the  armies  of 
Europe.  The  presence  or  absence  of  a  system  of  reglementation  has  no 
appreciable  influence  on  the  amount  of  such  disease. 

3.  The  introduction  of  reglementation  in  a  community  which  has  not 
had  such  a  system  does  not  affect  the  rate  of  morbidity;  if  any  effect  is 
produced  the  rate  increases. 

4.  The  suppression  of  reglementation  in  any  community  does  not  affect 
the  rate  of  venereal  morbidity,  but  this  rate  often  diminishes  after  the 
suspension  of  reglementation. 

5.  Prostitution  necessarily  brings  the  prostitutes  to  syphilis.  Reglemen- 
tation has  no  power  to  prevent  this  contamination. 

6.  It  cannot  be  proved  that  the  women  subjected  to  inspection  are  more 
free  from  infection  than  those  not  under  supervision.  Older  prostitutes  in 
any  case  are  more  immune  than  the  younger. 

7.  Reglementation  does  not  tend  to  free  prostitution  from  disease;  it 
renders  it  more  dangerous  by  keeping  women  from  seeking  treatment. 

8.  Those  infected  with  venereal  diseases  are  the  more  inclined  to  seek 
treatment  the  less  vigorous  is  the  supervision,  and  the  more  humane  and 
accessible  are  the  hospitals. 

9.  Reglementation  has  not  had  a  favorable  influence  on  venereal  mor- 
bidity; on  the  contrary  it  aggravates  it. 

Some  of  these  positions  were  sharply  contested  by  medical  men, 
especially  the  attempt  to  minimize  the  disastrous  results  of  venereal 
diseases.3  Attempts  at  control  are  made  by  France,  Belgium,  Ger- 
many, Russia,  Sweden,  Denmark,  Austria,  Hungary,  Roumania, 
Spain,  and  Portugal.  In  the  United  States,  England,  Norway, 
Holland  (except  Rotterdam),  Switzerland  (except  Geneva),  this 
policy  is  not  pursued.4 

Can  prostitutes  be  brought  under  control? 

In  all  places  and  especially  in  the  great  cities  attempts  to  suppress 
secret  prostitution  have  come  to  a  miserable  fiasco.  Thus  in  Paris  with  its 
approximately  4,000  registered  prostitutes,  estimates  of  secret  prostitutes 
run  from  10,000  to  120,000.  In  Berlin  there  are  only  3,500  public  and 
10,000  to  50,000  secret  harlots.  In  Vienna  there  are  1,700  to  2,000  registered 
and  from  20,000  to  60,000  secret  harlots.5 

3M.  F.  Hennequin,  Rapport  general  sur  les  travaux  de  la  Commission  Extra- 
parlementaire  du  Regime  des  Masurs,  1908. 

4  Gruber,  op.  cit.  5  Ibid.,  p.  16. 


58  THE  EIGHTH  YEARBOOK 

What  is  really  promised  by  the  advocates  of  the  German  license 
system?  Not  much.  S.  Bettman,  an  advocate  of  this  systern,  will 
say  no  more  than  this :  "Surely  no  greater  security  should  be 
promised  than  control  can  afford." 6  He  follows  Jadassohn  in 
advising  this  information  for  male  "clients"  of  the  inspected  har- 
lots, in  places  where  the  tolerance  and  inspection  system  obtains : 

1.  Every  prostitute,  i.  e.,  every  woman  who  engages  in  sexual  inter- 
course for  pay,  is  under  obligation  to  submit  herself  regularly  to  police 
investigation,  in  order  to  determine,  as  well  as  possible,  whether  she  is 
suffering  from  a  contagious  disease. 

2.  Every  prostitute  is  under  obligation  always  to  have  and  to  show  on 
request  a  card  with  her  photograph  similar  to  the  one  in  the  control  book. 

3.  Every  prostitute  who  has  not  this  evidence  is  in  the  highest  degree 
suspicious,  and  intercourse  with  her  is  particularly  dangerous. 

4.  The  card  contains  the  certificate  of  the  last  police  examination ;  and 
may  not  be  more  than  four  days  old. 

5.  But  even  prostitutes  who  are  regularly  examined  by  the  police  phy- 
sicians may  be  sick,  since  there  are  contagious  maladies  which  the  exami- 
nations cannot  disclose. 

6.  The  examination  gives  no  security  against  infection  with  venereal 
diseases,  but  can  merely  diminish  the  danger  of  infection  by  exclusion  of 
those  who  are  affected  certainly  and  in  a  high  degree. 

Regulations  of  this  character  are  not  an  invitation  to  men  to  engage  in 
immorality ;  they  operate  rather  as  a  deterrent,  and  also  indicate  satisfac- 
torily the  still  greater  risk  to  health  of  intercourse  with  prostitutes  who  are 
not  examined  by  police  physicians. 

To  one  who  is  really  sane  and  knows  all  the  facts  this  informa- 
tion would  exclude  all  but  men  sex  mad,  insane  from  lust  and 
drink.  But  fools  will  heed  nothing.  The  most  that  Bettman 
claims  is  a  reduction  of  the  probability  of  infection  for  a  certain 
case;  he  knows  well  that  any  man  who  persists  will  be  infected 
some  time.  The  question  is  whether  this  is  worth  what  it  costs ; 
whether  there  are  disadvantages  over  against  advantages ;  and 
whether  the  same  results  cannot  be  obtained  without  a  semblance 
of  license  by  some  better  method?  The  effort  to  make  the  control, 
examination,  and  treatment  thorough  drives  many  of  the  wretched 
women  to  avoid  the  registration  and  conceal  their  condition.  Men 
are  tempted  all  the  more  to  vicious  and  dangerous  indulgence  when 

6  Die  aerztliche  Ueberwachimg  der  Prostitution,  S.  Bettman,  p.   162.   163. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  59 

the  official  certificate  of  health  is  exhibited  by  the  temptress.  Fear 
is  allayed,  but  danger  is  by  no  means  removed.  There  is  no  safe 
way  to  sin.    Dr.  Gruber  declares : 

The  one  who  is  prostituted  or  who  has  intercourse  with  prostitutes  must 
be  informed  that  he  will  soon  or  late  become  infected  with  venereal  disease, 
even  with  the  dangerous  diseases  of  gonorrhea  and  syphilis." 7 

On  the  basis  of  a  local  investigation  in  the  city  of  Mannheim, 
Germany,  where  the  policy  of  inspection  prevails,  it  has  been 
affirmed  that  the  number  of  the  infected  is  still  so  great  that  the 
best  possible  control  offers  no  secure  protection  against  infection.6 

As  for  myself,  and  I  trust  I  speak  for  all  in  this  professedly  Christian 
land,  I  would  declare :  "We  cannot  consent  to  sanction  of  evil  that  good 
may  come  from  it."  ....  We  will  fight  evil  wherever  we  see  it,  and  under 
all  circumstances  we  will  oppose  the  debasement  of  the  public  standards 
of  right  and  morality.  This  we  will  do  in  entire  confidence  that  in  spite  of 
all  appearance  the  right  so  upheld  will  in  the  end  prove  victorious."  * 

The  venereal  diseases  belong  to  the  worst  accompaniments  of  the  sexual 

impulse Medicine,   in   connection   with  men's   eagerness   for   pleasure, 

has  hit  upon  the  most  absurd  and  debasing  arrangements  that  one  can 
imagine,  i.  e.,  state  toleration,  organization,  and  attempted  cleansing  of 
prostitution.  Under  the  pretext  of  a  sanitary  regulation,  they  compel 
prostitutes  to  enrol  themselves  in  houses  of  ill-fame  and  subject  them  there 
to  regular  medical  inspections  which  are  designed  to  remove  the  infected 
from  circulation  and  require  them  to  submit  to  treatment  in  the  hospital. 
It  is  evident  that  the  more  or  less  unsavory  service  of  a  prostitute's  phy- 
sician on  the  whole  (there  are  exceptions)  is  likely  to  be  followed  by 
physicians  of  inferior  grade.  We  shall  see  later  that  the  whole  system  fails 
of  its  purpose.  The  value  of  treatment  of  venereal  diseases  has  been 
greatly  overestimated The  only  adequate  treatment  of  venereal  infec- 

7  Gruber :  op.  cit.,  p.  30.  Proof  of  the  inefficiency  and  failure  of  all  methods 
of  government  regulation  are  given  by  Dr.  Max  Gruber,  Die  Prostitution  vom 
Standpunkte  der  Soaialhygiene  aus  betrachtet,  Vienna,  1905 ;  Dr.  Howard  A. 
Kelly,  "What  Is  the  Right  Attitude  of  the  Medical  Profession  Toward  the  Social 
Evil?"  paper  read  before  the  American  Medical  Association,  1904,  and  re- 
printed from  the  Journal  of  the  American  Medical  Association,  March  4,  1905, 
citing  an  article  by  Frederick  Griffith,  in  the  New  York  Medical  Record,  April 
23,  1904,  on  the  status  in  Paris;  James  Foster  Scott,  The  Sexual  Instinct.  1908 
(2d  ed.)  ;  G.  F.  Lydston,  Diseases  of  Society. 

*  Drs.  Lion  and  Loeb,  in  Sexualpddagogik ,  D.  G.  B.  G.,  p.  296. 

*  Dr.  Howard  A.  Kelly,  op.  cit.,  p.  6. 


60  THE  EIGHTH  YEARBOOK 

tion  is  to  avoid  it.  It  is  beyond  belief  that  honorable  women,  with  the 
idea  of  protecting  their  daughters  from  the  lust  of  men,  will  continue  to 
defend  such  barbaric  institutions  as  licensed  prostitution  and  regulation. 
Nothing  but  suggestion  of  men,  to  which  women  are  often  exposed,  can 
make  this  comprehensible.  That  many  men  and  physicians  defend  this 
system  arises  from  a  mixture  of  blind  conservatism,  faith  in  authority, 
and  incapacity  for  forming  a  judgment,  together  with  a  concealed,  often 
unconscious  eroticism.10 

What  must  be  the  influence  of  the  system  of  inspection  and 
control  on  members  of  the  medical  profession?  It  would  not  be 
true  to  assert  of  all  the  physicians  who  administer  this  system  in 
Europe  that  they  are  unworthy  of  their  high  profession.  If  the 
system  on  the  whole  were  the  best  for  society  men  of  character 
would  be  found  to  carry  it  out,  repulsive  as  it  might  be  in  certain 
aspects.  The  treatment  of  disease  cannot  fairly  be  judged  by 
aesthetic  standards.  From  the  outside  we  can  sympathize  with  the 
expression  of  disgust  with  which  even  physicians  repel  the  propo- 
sition to  introduce  Parisian  methods  in  American  cities.  Thus  a 
high-minded  medical  man  says : 

The  necessity  for  examining  women  licensed  to  carry  on  their  business 
will  create  in  our  midst  a  vile  and  odious  specialty,  akin  and  closely  allied 
to    the    professional    abortionist,    degrading    to    our    profession    and    partly 

bringing  it   into   contempt   by   making   it  thus   pander  to   vice Read 

Griffith's  article,  and  see  how  many  of  the  Paris  medical  men  are  employed 
with  two  tables  examining  prostitutes  at  the  rate  of  about  450  an  hour ! 
What  a  lowering  of  our  standards  when  we  come  to  that !  !u 

But  this  praiseworthy  repugnance  to  a  vile  task  does  not  meet 
all  the  difficulties.  Can  the  medical  profession  and  the  public 
authorities  leave  the  whole  matter  alone  and  do  nothing  to  cure  and 
mitigate  the  ravages  of  the  diseases  in  question? 

This  society  has  been  criticized  by  some  physicians  for  the  adoption  of 
a  policy  which  excludes  reglementation  from  its  scheme  of  work.  The 
failure  of  this  system  abroad  in  materially  decreasing  the  spread  of  disease, 
apart  from  objections  on  moral  grounds,  and  the  hostility  of  public  senti- 
ment in  this  country,  led  to  its  rejection.  It  would  seem  a  gross  incon- 
sistency for  a  society  which  holds  that  monogamy  is  the  only  sure  basis  of 

10  Dr  Forel,  Die  esexuelle  Frage,  pp.  230,  231. 

11  Dr.  Howard  A.  Kelly. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  6l 

the  social  order,  the  normal  productivity  and  progress  of  the  race,  to 
sanction  the  legal  recognition  of  a  class  of  women  set  apart  for  polygamous 
practices.  A  society  that  recommends  continence  as  the  surest  preventive 
of  venereal  infection  cannot  consistently  favor  a  legalized  provision  for 
incontinence.  We  cannot  afford  to  lower  the  standard  of  morality.  The 
supremacy  of  morals  in  private  or  public  life  can  never  be  established 
unless  we  hold  fast  to  those  immutable  principles  of  right  based  upon  the 
"moral  code,"  which  is  diametrically  opposed  to  the  "conventional  code  of 
morals." 

"Physicians,"  declares  Dr.  Osier,  "should  be  the  apostles  of  continence." 
Whether  or  not  the  individual  lives  of  its  members  conform  to  this 
standard,  the  medical  profession  in  its  corporate  capacity,  in  societies  and 
associations,  should  proclaim  the  doctrine,  based  upon  sound  physiology  and 
experience,  that  continence  is  not  prejudicial  to  health.  The  almost  uni- 
versal infection  of  the  minds  of  young  men  with  the  converse  of  this  doc- 
trine— the  so-called  "sexual  necessity" — is  in  my  opinion,  the  most  powerful 
determining  cause  of  masculine  immorality.12 

II.    THE  POLICY  OF  REPRESSION  :  THE  "ABOLITIONISTS" 

This  policy  aims  at  the  absolute  suppression  of  all  illicit  sexual 
intercourse.  It  requires,  in  order  to  be  effective,  that  every  harlot 
and  every  male  frequenter  of  rooms  or  houses  of  ill  fame  be 
arrested  and  severely  punished  by  fine  and  prolonged  imprison- 
ment. It  is  true  that  professional  prostitutes  can  be  driven  out  of 
rural  districts  and  villages  where  there  is  an  overwhelming  public 
opinion  in  favor  of  this  policy.  But  when  the  attempt  is  made  in 
cities  the  evil  is  scattered  but  not  exterminated.  Policemen  fre- 
quently accept  bribes  from  the  houses  of  ill  fame  as  "hush  money," 
and  in  return  protect  the  outcasts  from  interruption.  It  is  practi- 
cally impossible  to  secure  witnesses  for  prosecution.  What  man 
will  testify,  since  his  testimony  incriminates  himself?  What  woman 
of  ill  repute  can  be  brought  to  testify? 

It  is  very  easy  to  declaim  against  sexual  vice  and  demand  that 
the  authorities  exterminate  it  root  and  branch;  but  such  declama- 
tion seldom  takes  account  of  all  the  facts.  Does  any  person  who  is 
acquainted  with  our  great  cities  really  mean  to  propose  to  imprison 
as  criminals  the  unknown  thousands  of  miserable  women  who  sell 
body  and  soul  for  a  living?    Have  such  zealous  and  worthy  orators 

12  Dr.   Prince  A.   Morrow,  Sanitary  and  Moral  Prophylaxis. 


62  THE  EIGHTH  YEARBOOK 

even  figured  out  how  many  prisons  would  have  to  be  built  and 
maintained  to  carry  out  their  policy?  Have  they  taken  pains  to 
learn,  as  they  should  before  speaking,  how  impossible  it  would  be 
to  ferret  out  the  secret  prostitutes  which  the  most  vigilant  detectives 
in  European  cities  are  unable  to  discover?  Have  they  carefully 
studied  the  effects  of  attempts  to  treat  prostitutes  as  criminals 
already  made  in  obedience  to  occasional  moral  spasms  of  public 
interest  in  American  cities?  Have  they  ever  duly  thought  out  the 
demoralizing  tendency  on  courts  and  police?  Do  they  not  know 
what  a  deeply  rooted  vice  will  do  to  pay  hush  money  to  those  who 
are  given  power  to  imprison  the  offenders?  Have  they  duly  con- 
sidered the  revolting  injustice  of  a  policy  of  imprisoning  women 
for  an  offense  and  permitting  men,  their  accomplices  and  tempters, 
to  go  free  or  to  escape  with  a  fine  ? 

Frankly  we  must  give  up  the  policy  of  repression,  for  it  can 
be  nothing  more  than  a  sham  policy,  full  of  hypocrisy  and  corrup- 
tion, not  at  all  effective  for  its  purpose.  A  slower  but  more  funda- 
mental policy  must  be  found ;  a  policy  which  will  not  recognize  the 
profession  of  the  prostitute  as  legal  or  pretend  to  guarantee  the 
lustful  against  disease,  and  yet  will  work  steadily  toward  the  cure 
and  prevention  of  disease,  and  the  removal  of  the  causes. 

III.    THE  POLICY  OF   MORAL  REGULATION   OF  VICE 

The  essential  features  of  this  policy  are : 

i.  Repressive  features. — It  is  possible  for  the  police  force  of 
government  supported  by  wise  laws  and  enlightened  public  opinion, 
in  a  reasonable  degree,  to  prevent  the  open  and  public  solicitation 
of  the  temptress.  The  street  walker  can  be  arrested ;  those  who  sit 
at  open  windows  may  be  required  to  hide;  red  lights  and  other 
advertising  methods  may  be  suppressed ;  saloons,  dancing-halls,  and 
places  of  amusement  can  be  cleared  of  vicious  persons. 

2.  Preventive  features. — Children  must  be  rescued  from  the 
control  and  influence  of  vicious  parents  or  guardians.  The  respecta- 
ble tenants  of  tenement  houses  may  be  protected  against  the  inva- 
sion of  women  of  depraved  habits.  The  crowding  of  living  and 
sleeping-rooms,  promiscuous  and  intimate  association  of  persons  of 
both  sexes,  especially  of  boarders,  must  be  brought  under  munici- 
pal control.     Still  wider  measures  are  the  industrial  education  of 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  63 

girls,  vigorous  action  of  juvenile  courts  to  prevent  the  prostitution 
of  girls,  raising  of  wages  of  girls  to  a  decent  standard,  super- 
vision of  work  places  and  mercantile  establishments. 

3.  A  system  of  moral  regulation  must  recognize  the  demands  of 
the  medical  profession,  and  include  practical  measures  of  dealing 
with  infected  persons.  Physicians  should  be  trained  for  this  task. 
Quacks  should  be  rooted  out  and  newspapers  punished  for  insert- 
ing their  advertisements,  if  not  by  law  at  least  by  withdrawal  of 
patronage  of  subscribers  and  advertisers.  Dispensaries  and  hospi- 
tals should  admit  patients  suffering  from  these  maladies,  and  the 
cost  of  treatment  should  not  be  in  the  way  of  .the  admission  of 
anyone.  District  nurses  should  be  taught  to  discover  and  know 
how  to  advise  the  ignorant  and  poor.  Physicians  paid  by  the  public 
should  be  ready  to  treat  poor  persons  who  come  to  them.  The 
sacred  and  responsible  relations  of  marriage  should  be  guarded 
before  the  portal  by  a  state  law  requiring  a  medical  certificate  of 
an  official  physician  of  freedom  from  communicable  disease  as  a 
condition  of  receiving  a  license  to  marry. 

These  points  are  argued  at  length  in  the  report  of  the  Commit- 
tee of  Fifteen  in  the  volume  called  The  Social  Evil.13  The  writer  of 
this  Handbook  looks  upon  this  Report  as  the  most  sane,  high- 
minded,  and  practical  statement  which  has  come  to  his  notice. 

It  is  customary  to  speak  as  though  there  were  but  three  possible  ways 
of  dealing  with  prostitution,  absolute  laissez-faire,  absolute  prohibition  of 
vice,  and  rcglementation. 

It  is  very  cogently  argued  that  laissez-faire  is  an  inadmissible  policy. 
Not  only  does  venereal  disease  extend  its  ravages  unchecked,  but  every  sort 
of  moral  iniquity  thrives  wherever  vice  is  a  law  unto  itself.  With  equal 
cogency  it  is  argued  that  no  human  legislator  can  make  vicious  men  or 
women  virtuous,  or  preserve  so  close  a  surveillance  over  them  as  to  pre- 
vent the  exercise  of  their  evil  propensities.  Thus,  by  a  process  of  exclu- 
sion, rcglementation  is  arrived  at  as  the  only  rational  policy  for  govern- 
ment to  pursue. 

It  is  difficult  to  understand  how  such  naive  reasoning  can  still  be  enter- 
tained by  thinking  men.  Regulative  and  repressive  systems  differ  in  empha- 
sis, rather  than  in  essence.  The  first  aim  of  the  reglementationist  is  to 
check   disease ;   he  recognizes,   however,   the   gravity  of   vice   in   itself,   and 

13  Committee  of  Fifteen,   The  Social  Evil,  chap,  xi   (1902). 


64  THE  EIGHTH  YEARBOOK 

admits  that  no  measures  that  may  limit  its  volume  are  to  be  disregarded. 
The  opponent  of  reglementation,  while  believing  that  vice  itself  is  an  evil 
that  completely  overshadows  any  hygienic  effects  that  result  from  it,  will 
generally  admit  that  all  means  for  combating  venereal  disease  should  be 
adopted,  provided  that  they  are  not  directly  antagonistic  to  moral  ends. 
Accordingly,  we  find  many  elements,  both  moral  and  sanitary,  upon  which 
both  parties  agree.  A  system  of  control  based  upon  such  common  elements 
and  supplemented  somewhat  as  common-sense  suggests,  would  escape  the 
serious  charge,  now  brought  against  reglementation,  of  making  itself  auxili- 
ary to  prostitution,  and  would  at  the  same  time  be  free  from  the  moral  and 
hygienic  futility  of  violent  repression.  Such  a  system  would  abandon  the 
task  of  effecting  the  impossible,  in  either  morals  or  hygiene,  and  would 
reserve  the  powers  at  its  command  for  the  bringing  about  of  such  ameliora- 
tions as  experience  and  reason  have  shown  to  be  possible.  Such  a  system 
we  may  term  the  Moral  Regulation  of  Vice,  since  it  would  never  lose  sight 
of  the  fact  that  moral  considerations  are  of  paramount  importance. 

Repressive  features  in  moral  control. — The  first  point  upon  which 
all  are  agreed  is  the  necessity  of  suppressing,  so  far  as  possible,  flagrant 
incitement  to  debauch.  Solicitation  upon  the  street  and  in  public  places 
should  be  restrained ;  haunts  of  vice  should  be  compelled  to  assume  the 
appearance  of  decency;  in  short,  every  method  of  conspicuous  advertising 
of  vice  should  be  done  away  with.  It  is  admitted  that  this  can  only  ap- 
proximately be  accomplished.  The  prostitute  will  always  continue  to  make 
her  presence  known.  But  much  would  be  gained  if  vice  could  be  made 
relatively  inconspicuous  except  to  its  votaries.  The  constant  presence  of 
women  known  to  be  immoral  serves  to  recruit  each  year  the  patronage 
of  prostitution  by  inciting  to  vice  many  who  would  not  of  themselves  have 
sought  illicit  pleasures.  From  this  point  of  view,  it  is  far  better  that  prosti- 
tutes should  be  clandestine  in  fact  as  well  as  in  name  than  that  they  should 
appear  in  their  true  colors.  A  system  which  places  moral  ends  before  sani- 
tary would  be  just  as  capable  of  dealing  with  this  part  of  the  problem  as 
one  which  regards  sanitary  ends  as  paramount.  As  a  practical  fact,  the 
former  system  would  encounter  less  difficulty  than  the  latter,  since  the 
exigencies  of  sanitary  control  require  that  a  certain  latitude  of  flagrancy 
should  be  given  to  the  licensed  prostitute.  Reuss,  p.  87,  is  cited :  "From 
the  moment  that  by  inscription  a  semi-official  seal  is  placed  upon  prosti- 
tution, one  is  morally  bound  to  grant  the  women  upon  whom  obligations 
are  imposed  the  right  to  exercise  their  trade.  For  the  great  majority  of 
public  women,  solicitation  upon  the  street  is  the  only  kind  that  can  be 
employed.  The  street  where  they  elbow  the  passers-by,  furnishes  them  the 
means  of  their  existence ;   forbid  it  them,   and  they  die  of  hunger." 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  65 

The  pernicious  effect  of  a  league  between  vice  and  legitimate  pleasures 
has  been  mentioned  above.  Especially  dangerous  is  vice  in  public  drinking- 
places.     Women  are  engaged  to  persuade  men  to  drink   alcoholic   liquors 

to  excess;  the  effects  of  alcohol,  in  turn,  lend  service  to  vice It  will 

doubtless  be  impossible  to  keep  the  saloon  absolutely  free  from  the  presence 
of  prostitution,  and  to  prohibit  absolutely  the  sale  of  intoxicants  in  brothels. 
But  a  policy  which  should  revoke  the  license  of  a  saloonkeeper  who  permits 
unattended  women  to  frequent  his  premises  in  the  evening  and  night  would 
assist  in  driving  vice  from  the  saloonkeeper.  A  supplemental  policy  of 
discouraging  the  sale  of  liquors  in  so-called  hotels  would  be  needed  to 
make  the  plan  effective. 

In  like  manner,  the  dancing-hall  or  music-hall  which  lends  itself  to  the 
purposes  of  vice  is  a  public  nuisance  and  could  be  reached  by  the  police 
whenever  immorality  becomes  flagrantly  conspicuous. 

Vice  will  naturally  take  refuge  in  private  houses  if  denied  the  use  of 
public  places.  It  would  still  require  regulation  to  keep  it  within  the  bounds  of 
decency.  It  is  in  vain  that  it  is  driven  into  privacy  if  by  conspicuous 
lights  or  signs  or  by  noisy  music  it  is  permitted  to  make  its  presence  noto- 
rious. An  English  law  of  the  present  day  makes  it  possible  to  close  a 
house  if  it  is  shown  by  the  testimony  of  two  responsible  citizens  to  be 
used  for  immoral  purposes.  While  it  is  doubtful  whether  such  a  law  would 
have  any  other  effect  than  that  of  breaking  up  the  house  of  ill  fame  and 
compelling  prostitutes  to  resort  to  solicitation  upon  the  street,  an  analogous 
measure  which  should  permit  aggrieved  neighbors  to  close  a  house  which 
is  obtrusively  devoted  to  immorality  would  be  a  most  efficient  form  in  com- 
pelling such  establishments  to  conceal  their  true  character. 

We  may  here  consider  whether  moral  ends  are  best  subserved  by  rele- 
gating vice  to  a  single  quarter  of  the  city.  It  is  a  serious  question  whether 
the  house  of  ill  fame,  situated  in  a  respectable  locality  and  compelled  to 
preserve  an  outward  air  of  decency,  is  as  dangerous  to  the  community  at 
large  as  a  similar  establishment  surrounded  by  others  of  a  like  character 
and  hence  not  under  compulsion  to  refrain  from  flagrant  devices  for 
increasing  its  patronage. 

Preventive  features. — A  second  point  upon  which  all  parties  will  agree, 
is  the  desirability  of  keeping  growing  children  free  from  contact  with  pro- 
fessional vice.  The  child  who  knows  all  evil  is  almost  destined  to  share 
in  it.  No  child  over  three  years  of  age  should  be  permitted  in  a  house 
where  prostitution  is  carried  on.  In  tenements  and  flat-houses  parents  of 
children  should  be  able  to  bring  complaint  against  tenants  of  tenements 
or  flats  in  the  same  building  when  suspicion  is  created  that  prostitution  is 
carried   on   in   such  tenements   and   if   the   suspicion   is   found   to   be   based 


66  THE  EIGHTH   YEARBOOK 

upon  reasonable  grounds,  the  courts  should  require  the  landlord  to  evict  the 
suspected  parties.  The  evil  is  one  of  such  gravity  that  it  would  seem  to 
justify  a  measure  which  interfered,  to  a  certain  extent,  with  the  principle 
of  inviolability  of  domicile. 

Even  where  the  children  of  the  poor  are  not  in  immediate  contact  with 
professional  vice,  their  surroundings  are  frequently  highly  inimical  to 
virtue.    When  a  whole  family,  adults  and  children  of  both  sexes,  is  crowded 

together   in   a   single   room,   moral   degradation    is   almost   inevitable 

The  problem  is  one  of  the  most  intricate  with  which  society  has  to  deal, 
since  the  incomes  of  the  poor  and  the  rents  which  they  have  to  pay  are 
almost  entirely  fixed  by  laws  over  which  government  has  little  control. 
Nevertheless,  the  question  may  be  raised  whether  it  is  not  possible  by  means 
of  restrictions  upon  the  building  and  letting  of  houses,  to  discourage  the 
formation  of  quarters  that  inevitably  entail  upon  the  community  a  most 
serious  burden  of  vice  and  disease 14 

The  report  further  suggests :  industrial  education  of  girls,  to 
help  them  to  be  self-supporting  by  honest  industry;  the  prevention 
of  the  prostitution  of  minors  by  the  care  of  neglected  children,  and, 
we  may  add,  juvenile  courts. 

General  practitioners  should  be  required  to  possess  a  high  degree  of 
knowledge  in  the  treatment  of  venereal  maladies The  quack  phy- 
sician who  practically  fosters  disease  for  his  own  ends  should  be  eliminated. 
Treatment  for  venereal  disease  should  be  within  the  reach  of  all.  The 
cost  of  adequate  treatment  for  the  more  serious  forms  of  venereal  maladies 
is  so  great  that  the  vast  majority  of  patients  cannot  be  treated  at  all  except 
at  public  hospitals  and  dispensaries.  These  should,  accordingly,  be  numer- 
ous enough  to  furnish  gratuitous  treatment  to  all  who  desire  it.  Patients 
should  be  encouraged  to  appear  for  treatment ;  every  care  should  be  taken 
to  insure  them  against  exposure,  since  many  would  rather  endure  their 
maladies  in  secret  than  permit  it  to  be  known  that  they  suffer  from  a 
shameful  disease."  If  publicity  cannot  be  avoided  at  public  dispensaries, 
it  would  be  for  the  general  welfare  to  designate  officially  private  physicians 
in  each  quarter  of  the  city,  who  should  treat  such  patients  free  of  charge, 
receiving  their  compensation  from  the  public  treasury. 

Dr.  Morrow  says  that  facilities  for  such  treatment  in  New 
York  City  are  inadequate;  probably  this  is  true  in  most  if  not  all 
our  cities. 

Objection  will  doubtless  be  raised  that  such  measures  would  mini- 
mize the  deterrent  effect  that  is  exercised  by  venereal  disease  upon  those 

14  The  Social  Evil. 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  67 

who  wish  to  indulge  in  vice.  It  is  a  sufficient  answer  that  the  chronic 
results  of  disease  are  frequently  even  more  disastrous  to  innocent  parties 
than  to  the  sufferer  himself.  Moreover,  the  immediate  consequences  of 
disease  are  sufficiently  grave  to  act  as  deterrent  for  those  who  can  be 
deterred  from  vice  by  fear  of  disease.  It  is  doubtful  whether  the  distantly 
remote  consequences  are  weighed  at  all. 

Finally,  a  system  of  moral  control  cannot  overlook  the  fact  that  venereal 
disease  is  frequently  transmitted  to  innocent  persons.  It  is  difficult  to  see 
how  this  evil  can  be  remedied  except  by  the  requirement,  as  a  preliminary 
condition  to  the  issuing  of  a  marriage  license,  of  a  certificate  from  an 
official  physician  showing  the  present  state  of  health  of  each  of  the  con- 
tracting parties.  Such  a  requirement  would  work  no  real  hardship  to  any- 
one, since  few  persons  who  suspected  the  existence  of  a  disease  of  this 
kind  would  apply  for  an  official  examination'  before  health  had  been  re- 
stored. It  will  be  admitted  that  many  difficulties  would  arise  in  the  adminis- 
tration of  such  a  law,  and  that  it  could  only  diminish  somewhat  the  evil 
which  it  is  designed  to  meet.  The  evil  in  question  is,  however,  one  of  so 
revolting  a  nature  that  any  amelioration  would  be  worth  a  heavy  cost. 

The  report  urges  the  appointment  of  a  special  body  of  police 
agents  for  the  administration  of  the  system. 

For  the  introduction  of  a  system  of  control  embodying  the  above  fea- 
tures several  state  laws  would  be  needed.  But  whereas  reglementation 
would  with  difficulty  find  a  place  under  the  Constitution,  a  system  of  moral 
control  would  be  open  to  no  objections  on  the  score  of  constitutional  law. 
What  is  of  greater  importance,  any  good  that  might  result  from  regie- 
mentation  is  fatally  tainted  with  evil ;  whatever  good  might  result  from 
moral  control  is  good  unmixed.  Reglementation  would  arouse  the  uncom- 
promising hostility  of  a  great  part  of  the  community;  intelligent  moral 
control  would  meet  with  the  approval  of  all,  excepting  of  those  who  are 
not  satisfied  with  a  plan  which  would  only  gradually  bring  about  moral 
and  sanitary  improvement,  and  who  dream  that  there  is  some  royal  road 
to  the  instant  abolition  of  either  moral  or  sanitary  evil. 

The  Detroit  method  may — with  some  misgivings — be  mentioned 
under  the  plans  for  the  mitigation  of  evils.  Some  think  it  only 
license  under  a  new  name.  Dr.  Guy  L.  Kiefer,  health  officer  of 
Detroit,  says : 

The    following   method    as   practiced    here    has   been    in   use    about   two 

months The    keepers    of    all    houses    of    prostitution    known    to    the 

police  have  been  notified  that  certificates  of  health  will  no  longer  be  required 
nor  accepted  by  the  board  of  health.     The  board  does  not  care  about  cer- 


68  THE  EIGHTH  YEARBOOK 

tificates,  but  does  care  about  health.  It  is  its  duty  to  prevent,  so  far  as 
possible,  the  spread  of  all  contagious  diseases,  and  venereal  diseases  are 
contagious."  w 

Therefore  on  and  after  January  i  the  health  officer,  or  some  phy- 
sician delegated  by  him,  will  visit  these  houses  at  unannounced  and 
irregular  intervals  and  examine  the  inmates.  If  any  are  found 
with  a  contagious  disease  (gonorrhea  or  syphilis)  they  will  be 
quarantined.  The  placard  used  on  these  houses  is  a  large  yellow 
card  with  the  one  word  "quarantined"  printed  on  it  in  conspicuous, 
heavy,  black  letters.  The  keeper  of  the  house  then  agrees  to  send 
the  woman  to  a  hospital  for  treatment  at  her  own  expense.  "There, 
after  a  thorough  examination,  clinical  and  bacteriologic,  by  a  phy- 
sician of  the  board  of  health,  when  found  recovered,  she  was 
allowed  to  go."  The  houses  are  not  licensed,  but  these  diseases  are 
treated  like  other  contagious  diseases.  An  officer  must  be  con- 
stantly at  work.  The  plan  is  merely  partial  and  palliative :  many  of 
the  women  will  escape  notice  and  go  on  infecting  men ;  and  in  inter- 
vals of  visits  will  infect  many. 

Educational  methods  of  the  state  of  Indiana. — In  the  year  1905 
the  legislature  of  Indiana  passed  a  law,  which  was  designed  to 
prevent  the  issuance  of  licenses  to  marry  in  cases  of  unfit  persons. 
The  Board  of  Health  of  Indiana  caused  to  be  distributed  a  large 
number  of  cards  on  which  were  printed  "facts  about  tuberculosis, 
gonorrhea,  and  syphilis." 

New  French  Bill — We  here  insert  a  summary  of  the  chief  points 
of  a  bill  recommended  to  the  French  parliament  as  a  result  of  an  in- 
vestigation covering  the  experience  of  more  than  a  century  and  a  dis- 
cussion of  some  of  the  most  competent  men  in  France  during  a  period 
of  three  years.10  This  bill  (Projet  de  loi  concernant  la  prostitution  et 
la  prophylaxie  des  maladies  veneriennes)  aims  to  take  from  the 
police  the  power  of  arbitrary  arrest  on  suspicion,  the  power  to 
punish  without  trial  and  all  forms  of  legal  tolerance,  enforced 
inscription  and  medical  inspection,  with  certificates  of  health  which 
were  condemned  by  a  majority  of  the  commission,   not  without 

15  Journal  of  the  American  Medical  Association,  March  21,  1908,  p.  97. 

18  Rapport  general  sur  les  travaux  de  la  Commission  Extra-parlementaire  du 
Regime  des  Maurs,  presente  par  M.  F.  FIcrinequin.  Melun,  1908.  2  vols.,  pp. 
285,  534- 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  69 

protest  from  strong  medical  authorities.  This  bill  aims  positively 
to  prevent  public  solicitation  and  temptation,  the  seduction  and 
ruin  of  girls,  and  to  provide  all  possible  means  of  healing  diseases 
and  limiting  the  spread  of  venereal  poisons. 

1.  Among  the  general  provisions  of  the  bill  are  (Titre  I)  : 
Prostitutes  shall  not  be  deprived  of  liberty  except  by  due  process 
of  law;  they  shall  not  be  compelled  to  register  on  a  list  of  prosti- 
tutes and  be  subject  to  enforced  inspection. 

2.  Minors  are  protected  from  moral  peril  (Titre  II)  :  if  under 
the  age  of  eighteen,  and  habitually  immoral,  they  may  be  brought 
before  a  civil  court  and  placed  under  the  care  of  an  institution  for 
reformatory  education  up  to  majority  or  marriage.  A  useful  in- 
dustry is  taught  and  money  for  a  start  in  life  furnished  out  of  the 
earnings  upon  discharge. 

3.  Public  solicitation  to  sexual  immorality  is  brought  under  the 
law  (Titre  III),  and  the  penal  code  is  modified  to  provide  fine  and 
imprisonment  for  the  offense. 

4.  The  attempt  to  incite  to  evil  conduct,  notorious  cohabitation 
for  debauch,  and  the  renting  of  a  dwelling  knowingly  to  prosti- 
tutes are  brought  under  the  Penal  Code  (Titre  IV).  The  police 
are  forbidden  to  enter  a  domicile,  however,  except  in  case  of  tumult 
or  where  a  person's  safety  is  in  danger. 

5.  Preventive  measures  (Titre  V).  Prostitutes  arrested  under 
the  law  and  found  to  be  infected  may  be  required  to  take  medical 
treatment,  if  they  do  not  submit  to  it  voluntarily.  On  complaint 
any  man  or  woman  guilty  of  communicating  a  contagious  venereal 
disease  may  be  punished.  Quack  advertisements  are  brought  under 
control.  Hospitals  are  required  to  accept  venereal  cases  for  treat- 
ment. Dispensaries  and  consultations  by  physicians  are  provided 
for  and  exposure  is  forbidden.  In  all  medical  schools  the  young 
physicians  must  have  instruction  in  venereal  diseases.  Mutual 
benefit  societies  must  not  refuse  aid  to  members  requiring  medical 
aid  for  those  maladies. 

Mention  may  be  made  here  of  the  problem  of  isolating  the 
houses  of  ill  fame  with  a  view  to  removing  them  as  far  as  possible 
from  contact  with  children  and  youth.  This  involves,  on  the  part 
of  the  police,  a  certain  kind  of  silent  toleration  and  the  suspension 
of  laws  making  it  criminal  to  rent  houses  to  be  used  for  immoral 


70  THE  EIGHTH  YEARBOOK 

purposes.  On  this  knotty  subject  opinions  of  thoughtful  people 
differ  widely.  In  some  degree  this  is  the  actual  policy  followed  in 
American  cities,  with  spasmodic  arrests — sometimes  more  in  the 
interest  of  fees  and  bribes  to  policemen  than  with  any  real  good  to 
the  community.  On  segregation  we  have  the  views  of  Dr.  E.  Lesser 
(Verhiitung  und  Bekdmpfung,  etc.)  : 

On  the  restriction  of  prostitutes  to  certain  houses. — I  may  say  at  the 
very  beginning  that  from  a  hygienic  standpoint  I  do  not  ascribe  to  this 
question  a  very  great  importance,  although  there  can  be  no  doubt  that  it 
would  be  very  much  easier  to  control  the  conditions  of  health  with  harlots 
in  the  houses  and  to  bring  medical  treatment  to  those  who  are  sick.  Still 
on  the  other  hand  it  is  very  certain  that  at  present  under  no  conditions  is 
it  possible  to  shut  up  all  the  prostitutes  of  a  great  city  or  even  the  greater 
part  of  them  in  such  houses.  The  hygienic  conditions  of  the  prostitutes 
outside  of  the  houses  would  naturally  in  no  way  be  touched  by  this 
arrangement,  and  therefore  we  must,  even  along  with  the  existence  of 
tolerated  houses  with  the  greater  number  of  prostitutes  who  live  where 
they  please,  employ  the  means  we  have  before  described  and  some  others 
in  order  to  secure  sanitary  conditions. 

But  in  an  entirely  different  relation,  by  partial  restriction  to  certain 
places,  that  is  by  a  partial  compulsion  to  live  in  certain  localities  and  streets, 
an  advantage  might  be  gained.  This  is  not  too  much  to  say  when  for  the 
majority  of  the  largest  cities  the  claim  is  made  that  in  them  prostitution 
is  almost  ubiquitous.  I  am  satisfied  that,  for  example  here  in  Berlin,  there 
are  not  many  streets  in  which  there  are  no  prostitutes,  and  that  on  the 
other  hand  there  are  streets  in  which  one  or  more  prostitutes  live  in  almost 
every  house,  and  when  we  consider  that  by  far  the  greatest  number  of 
prostitutes  dwell  in  the  quarters  occupied  by  the  poor  families  in  the  great 
tenement  houses  it  is  apparent  without  anything  further  that  there  is  a  I 
very  great  demoralizing  influence  which  is  exercised  by  this  universal 
presence  of  prostitution  among  the  population.  Even  if  in  the  dwellings 
where  prostitutes  dwell  there  are  no  children,  yet  on  the  same  floor  or  in 
the  house  there  may  be  children  and  growing  youths  and  maidens  who 
day  by  day  have  before  them  the  shameless  conduct  of  these  prostitutes. 
It  appears  self-evident  that  the  sense  of  modesty  is  dulled  by  this  means 
and  that  moral  self-control  is  disturbed  and  that  those  who  are  in 
danger  are  easily  brought  to  the  steep  places  of  vice.  To  set  aside  this 
demoralizing  influence  of  prostitution  altogether  naturally  is  something  that 
can  never  be  done,  but  even  by  a  partial  sequestration  of  prostitution  at 
least    a    partial    improvement    of    the    situation    can    be    made    and    also    in 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  71 

another  direction  the  restriction  of  a  number  of  prostitutes  to  several  civic 
localities  would  make  an  improvement  possible.  I  mean  the  diminution  of 
the  solicitation  by  prostitutes  on  the  open  streets.  The  conditions  in  a 
great  number  of  the  great  streets  of  the  larger  cities  and  those  also  in 
Berlin  are  in  fact  greatly  to  be  deplored.  It  is  almost  incredible  with  what 
openness  the  majority  of  the  prostitutes  conduct  their  solicitation  on  the 
streets,  and  how  in  consequence  certain  streets  have  been  taken  posses- 
sion of  by  the  prostitutes  to  such  an  extent  that  in  the  evening  or  at  night 
decent  women  or  girls  cannot  pass  through  these  streets  because  they  are 
considered  prostitutes  and  are  assailed  by  men  in  the  most  disagreeable 
way. 

Ability  to  resist  temptation,  especially  on  the  streets,  is  a  serious  factor, 
as  can  easily  be  understood.  The  man  who  is  going  on  his  way  quietly 
without  sexual  intentions,  finally,  after  he  has  been  again  and  again  attacked 
and  the  sexual  nature  disturbed,  yields  and  follows  the  last  of  the  prostitutes 
who  speaks  to  him.  The  same  man  would  under  no  conditions  go  to  a 
house  of  ill  fame,  because  this  would  imply  a  previous  sexual  purpose. 
That  the  incitements  on  the  street  have  a  great  influence  on  the  increase  of 
sexual  intercourse  with  prostitutes  there  can  be  no  doubt,  and  for  this 
reason  restriction  or  segregation  of  a  number  of  prostitutes  would  offer  an 
immediate  improvement,  although  of  course  a  complete  suppression  of 
provocation  on  the  street  cannot  be  regarded  as  possible. 

The  control  of  employment  bureaus. — The  connection  between 
the  social  evil  and  bureaus  of  employment  in  our  large  cities  is 
described  with  painful  accuracy  from  direct  personal  observation 
by  Frances  A.  Kellor  in  her  book  Out  of  Work,  Putnams  (1904). 
She  says: 

But  the  ....  business  methods  and  the  frauds  pale  into  insignificance 
beside  conscious  deliberate  immorality  of  many  offices  and  the  traps  they 
set  for  their  unwary  and  helpless  victims.  Of  these  the  honest  employer 
knows  but  little  and  the  employee  recalls  many  escapes.  The  bare  fact 
is  that  while  advertising  honest  work  and  while  furnishing  it  to  some,  many 
also  degrade,  debase,  and  ruin  others  and  later  cast  them  out  moral  and 
physical  wrecks.  Not  only  are  they  robbed  of  their  small  savings,  hoarded 
like  animals,  and  subjected  to  many  indignities  by  proprietors,  but  they 
must  submit  to  association  with  and  temptation  by  street  walkers  and 
immoral  men.  Not  only  must  they  lodge  under  conditions  which  rob 
them  of  their  self-respect,  but  unsuspectingly  they  are  sold  into  disreputa- 
ble houses  and  held  as  prisoners. 

Not  all   offices  are  engaged   in  this   work,   though  with   few   exceptions 


72  THE  EIGHTH  YEARBOOK 

they  are  careless  in  making  inquiries  where  girls  are  sent.  Figures  can 
only  be  approximate,  but  it  is  no  exaggeration  to  say,  that  in  New  York, 
Philadelphia,  and  Chicago,  about  75  per  cent,  are  not  averse  to  sending 
women  as  employees  to  questionable  places,  and  from  40  to  60  per  cent, 
send  them  as  inmates,   obtaining  their  consent  when  possible. 

The  details  given  by  Miss  Kellor  are  painful  and  startling  in 
the  extreme  but  must  be  read  in  her  interesting  volume. 

This  chapter  is  in  no  sense  of  the  word  intended  as  a  contribution  to 
the  extent  of  dealing  with  the  social  evil,  whether  it  shall  be  regulated, 
exterminated,  licensed,  tolerated,  or  whether  it  is  necessary  or  otherwise.  Its 
sole  purpose  is  to  show  one  source  of  supply — places  where  unwilling  recruits 
are  secured ;  and  to  insist  that  some  methods  are  unfair  and  that  some 
offices  are  sailing  under  false  colors.  Even  granting  that  neither  regulation 
nor  segregation  will  affect  the  demand,  one  thing  is  certain:  increase  the 
risk  and  the  majority  of  such  offices  will  retrench  their  work  or  go  out 
of  business,  for  they  will  do  nothing  that  will  not  pay — and  honest,  igno- 
rant, and  helpless  girls  will  be  much  better  protected ;  for  disreputable 
houses  cannot  so  readily  reach  women  who  are  penniless,  friendless,  and 
discouraged — the  time  when  such  proposals  are  most  favorably  received. 

Associations  for  combating  the  social  evil. — Teachers  should  be 
acquainted  with  the  more  important  organizations  working  on 
behalf  of  social  purity.  These  organizations  have  grown  rapidly 
in  numbers  and  in  power  during  the  past  decade  as  the  public  is 
becoming  more  intelligent  An  article  in  the  new  Encyclopedia  of 
Social  Reform,  by  Dr.  Bliss,  p.  1127,  gives  some  information: 

In  Europe  there  is  a  National  Federation  for  the  Abolition  of  State 
Regulation  of  Vice.  Its  headquarters  are  at  Geneva,  Switzerland,  and  it 
has  committees  in  various  countries.  This  federation  publishes  sixteen 
different  periodicals  in  seven  different  languages.  The  British  Committee 
has  its  office  at  17  Tothill  Street,  Westminister,  S.  W.,  London,  England. 
The  secretary  is  Mr.  Maurice  Gregory  and  the  organ  of  that  office  is  called 
The  Shield.  The  International  Bureau  for  the  Suppression  of  the  White 
Slave  Taffic  has  for  its  secretary  Mr.  William  Alexander  Cotte,  with 
offices  at  St.  Mary's  Chambers,  161-A  Strand,  London,  W.  C.  This  bureau 
has  a  committee  known  as  a  National  Vigilance  Committee  with  a  branch 
in  the  United  States.  Dr.  O.  Edward  Janney  of  Baltimore  is  the  chair- 
man of  this  committee  in  this  country,  and  state  associations  have  been 
formed.  The  White  Cross  Society,  established  by  the  Bishop  of  Durham, 
England,   in    1883,   and   taken   up   in   this   country   by  Rev.    B.   F.    DeCosta, 


PATHOLOGICAL,  ECONOMIC,  AND  SOCIAL  ASPECTS  73 

D.D.  should  be  mentioned.  The  principal  purposes  of  this  organization  are. 
First,  to  urge  upon  men  the  obligation  of  personal  purity;  second,  to  raise 
the  level  of  public  opinion  upon  public  morality ;  third,  to  secure  proper 
legislation  in  connection  with  morality.  The  New  England  Watch  and  Ward 
Society,  having  as  its  secretary  Mr.  J.  Frank  Chase,  Boston,  Mass.,  is  one 
of  the  oldest  societies  in  this  country.  It  combats  obscene  literature, 
gambling,  and  vice.  The  New  York  Association  for  the  Suppression  of 
Vice,  led  by  Mr.  Anthony  Comstock,  devotes  its  efforts  chiefly  against 
obscene  literature  and  degrading  instruments  of  vice.  The  American 
Society  of  Sanitary  and  Moral  Prophylaxis  seeks  to  limit  the  spread  of  dis- 
eases which  have  their  origin  in  social  evil.  It  was  founded  by  the  emi- 
nent physician,  Dr.  Prince  A.  Morrow  of  New  York  City.  A  society  with 
similar  purposes  is  established  in  Chicago — The  Chicago  Society  of  Social 
Hygiene — and  the  Milwaukee  Society  for  Sanitary  and  Moral  Education. 
There  are  others.  All  work  largely  through  publications.  The  Women's 
Christian  Temperance  Union ;  the  Young  Women's  and  Young  Men's 
Christian  Associations ;  the  King's  Daughters ;  the  National  Council  of 
Women ;  the  Congress  of  Mothers ;  many  women's  clubs  and  various  law 
and  order  societies  in  our  cities  have  all  undertaken  this  crusade.  In  most 
of  the  large  cities  may  be  found  the  rescue  missions  of  the  Catholic  church 
and  of  other  denominations  of  Christians,  and  the  Florence  Crittenden 
missions.  The  Health  Education  League  at  113  Devonshire  Street,  Boston, 
Mass.,  publishes  as  No.  16  in  the  "Health  Education  Series"  a  little  cir- 
cular on  Sexual  Hygiene,  by  a  member  of  the  Massachusetts  medical  society 
This  league  is  doing  excellent  work. 

Origin  of  the  Society  of  Sanitary  and  Moral  Prophylaxis  in  this  country. 
— The  first  gun  fired  in  this  movement  was  a  paper  on  "The  Prophylaxis 
of  Venereal  Diseases  in  New  York  City,"  read  before  the  Medical  Society 
of  the  County  of  New  York,  February,  1901.  This  was  followed  by  the 
report  of  the  Committee  of  Seven,  New  York,  in  December,  1901.  An 
effort  was  then  made  to  organize  a  society  for  the  study  and  prevention 
of  venereal  diseases  in  this  country,  but  it  met  with  neither  medical  nor 
lay  support.  Social  Diseases  and  Marriage  was  written  in  1903  largely  with 
a  view  of  creating  a  professional  sentiment  in  favor  of  this  work.  This 
was  followed  by  a  "Plea  for  the  Organization  of  a  Society  of  Sanitary  and 
Moral  Prophylaxis"  read  before  the  New  York  County  Medical  Society  in 
May,  1904.  Finally  after  months  of  personal  solicitation  the  following 
named  gentlemen  united  with  me  in  a  call  for  a  meeting,  February  8, 
1905,  to  discuss  the  wisdom  and  expediency  of  forming  a  society  for  the 
prevention   of   social   diseases :   Dr.   Stephen   Smith,   Dr.   Edward   L.   Keyes, 


74  THE  EIGHTH  YEARBOOK 

Dr.  George  B.  Fowler,  Dr.  L.  Bolton  Bangs,  Dr.  Edward  L.  Janeway,  and 
Dr.  Abraham  Jacobi.17 

Conclusion. — The  sexual  appetite  is  natural  and  universal ;  it 
serves  a  purpose.  But  it  must  be  regarded  from  the  social  stand- 
point, in  connection  with  the  duty  of  having  and  caring  for  chil- 
dren, not  from  the  selfish  standpoint,  as  a  mere  means  of  fleshly 
gratification,  with  no  moral  or  social  object.  This  is  the  essential 
evil.18  The  state  must  tolerate  and  control;  it  ought  not  to  recog- 
nize prostitution  in  any  way  as  legitimate.  At  best,  law,  police, 
government  can  do  little  more  than  affect  the  external  conduct; 
they  do  not  reach  the  springs  of  action,  the  habitual  incentives,  the 
active  ideas,  the  personal  motives,  the  spiritual  valuations  of  satis- 
factions. Admitting  all  that  may  properly  be  claimed  for  the 
favorable  reaction  of  even  compulsory  observance  of  decent  require- 
ments on  the  inner  life,  we  must  look  to  some  influence  far  deeper 
and  more  pervasive  for  the  ultimate  self-regulation  of  life  in  accord- 
ance with  the  laws  of  social  welfare  and  of  the  noblest  life.  This 
influence  is  education,  and  therefore  we  now  turn  from  the  medical 
profession  and  from  the  statesmen  to  that  profession  which  deals 
with  the  character,  the  will,  the  moral  nature  in  the  most  direct  and 
persuasive  way;  we  make  our  appeal  to  the  school  teachers,  the 
parents,  the  spiritual  counselors  of  children  and  youth.  This  will 
be  the  theme  of  the  other  part  of  this  Handbook. 

17  From  letter  of  Dr.  Prince  A.  Morrow  to  the  writer. 

18  Cf.  Max  Gruber,  Die  Prostitution,  p.  33. 


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